Aoun Salah G, El Ahmadieh Tarek Y, Vance Awais Z, Neeley Om, Morrill Kevin C
Neurosurgery, University of Texas Southwestern Medical Center, Dallas, USA.
Cureus. 2019 Mar 11;11(3):e4221. doi: 10.7759/cureus.4221.
Tethered cord syndrome (TCS) is a clinical diagnosis that can be difficult to establish, as symptoms do not always match classic radiological findings, such as a low-lying conus. Surgery for spinal detethering is not without risk and does not always result in clinical improvement. Prone magnetic resonance imaging (MRI) has been described as a tool to assess the mobility of the spine. This is a technical imaging report where prone imaging was a factor that influenced the decision to defer surgery in favor of conservative management. T1 and T2 sagittal and T1 axial MRI imaging were obtained with the patient supine, and then repeated in the prone position. An anteroposterior conus movement of >10% of the canal width was considered normal. There was significant anterior movement of the conus when switching to the prone position. Surgery was deferred, and the patient improved after a regimen of intensive physical therapy. Prone MRI can be a useful tool to have in our neurosurgical armamentarium when assessing spinal cord tethering. Surgery is not recommended when normal anteroposterior movement of the conus is present.
脊髓拴系综合征（TCS）是一种临床诊断，有时难以确立，因为症状并不总是与典型的影像学表现相符，比如脊髓圆锥低位。脊髓松解手术并非毫无风险，而且并不总能带来临床症状的改善。俯卧位磁共振成像（MRI）已被视作评估脊柱活动度的一种手段。这是一份技术影像报告，其中俯卧位成像在影响决策方面起到了作用，即决定推迟手术而选择保守治疗。在患者仰卧位时获取T1和T2矢状位以及T1轴位MRI影像，然后让患者转为俯卧位后再次进行扫描。脊髓圆锥前后移动幅度大于椎管宽度的10%被视为正常。转为俯卧位时脊髓圆锥出现了显著的向前移动。手术被推迟，患者在接受强化物理治疗方案后病情有所改善。在评估脊髓拴系时，俯卧位MRI可以成为我们神经外科手段中的一种有用工具。当脊髓圆锥存在正常的前后移动时，不建议进行手术。
