TETHERED THORACIC CORD RESULTING FROM SPINAL-CORD HERNIATION

Tethered cord syndrome (TCS) usually involves tethering of the lower c ord at the conus medullaris from dural abnormalities, but may occur af ter spinal cord herniation. A tethered thoracic spinal cord is rare, W e present an unusual case of a 30-year-old woman with a history of mye lopathy presumed to be secondary to T6 cord compression resulting from T6-T8 arachnoid cyst. She continued to deteriorate after partial exci sion of the cyst. Repeat magnetic resonance imaging suggested recurren ce of the presumed arachnoid cyst with cord compression and showed tet hering at TG-Tg. Surgical exploration revealed myelocele with cord her niation through the anterior thoracic dura. Pathologic diagnosis showe d neural tissue with gliosis. After physical therapy treatments, the p atient]lad increased lower extremity strength, ambulated with a cane, and regained some bladder control. Progressive myelopathy map represen t tethering of the cord resulting from cord herniation. Early recognit ion of TCS, even in patients with minimal neurologic deficits, could p revent progressive disability. (C) 1997 by the American Congress of Re habilitation Medicine and the American Academy of Physical Medicine an d Rehabilitation.