Tethered Cord Evaluation and Perioperative Management — Signs and Symptoms — Clinical Pathway: Inpatient and Primary Care

Tethered Cord Evaluation and Perioperative Management Clinical Pathway — Inpatient and Primary Care

Tethered Cord Signs and Symptoms

For acute neurologic symptoms, recommend ED referral or urgent neurosurgical consultation (1-800-TRY-CHOP) during business hours. After hours, refer to the ED.

Signs
  • Dark hairy patch located midline along the spine in the thoracic or lumbar region
  • Spinal lipomas or mass along spine
  • Hemangioma along spine, not always midline
  • Y-shaped or deviated gluteal crease
  • Sacral dimple located above gluteal crease
  • Coccygeal pit located within gluteal crease
Symptoms
  • Weakness
  • Paresthesias
  • Neurologic club foot (talipes equinovarus)
  • Lower back pain
  • Urinary or bowel dysfunction
Imaging and Follow-up Recommendations
≤ 6 mos
Ultrasound
> 6 mos or Abnormal Ultrasound
  • MRI lumbar spine without contrast, request tether protocol
  • May require sedation
  • Normal Ultrasound
    No follow-up required unless child develops new symptoms
  • Abnormal Ultrasound
    Call 1-800-TRY-CHOP
    for Neurosurgery appointment within 4 wks
  • Normal MRI
    No follow-up required unless child develops new symptoms
  • Abnormal MRI
    Call 1-800-TRY-CHOP
    for Neurosurgery appointment within 4 wks