Clinical question: Evaluate for spinal dysraphism, tethered cord, mass or lesion. Signs and symptoms: New onset of diurnal enuresis, sacral dimple, scoliosis. Nonenhanced cervical spine MRI:There is normal anatomical developmental vertebral column and with normal anatomical alignment.Unremarkable images at the level of foramen magnum.No evidence of spinal stenosis or neural foraminal compromise at any level.There is normal signal intensity and caliber of the cervical cord.Nonenhanced thoracic and lumbar MRI:Examination demonstrates congenital anatomical anomaly of T9 hemivertebrae on the right and partial articulation of T8 and T10 vertebral bodies. Finding is best appreciated on sagittal T2 series on images 3 through 8. Changes at this level results in significant dextroscoliosis. Counting from above the right hemivertebrae counts as T9. The rest of the thoracic spine demonstrate normal signal intensity and morphology of vertebral column however with 2 normally developed extra vertebral bodies. Evaluation of the lumbosacral spine demonstrate normal anatomical development of the vertebral column. With best estimate counting from L5-S1 superiorly there is apparent normal termination of the cord at L1-L2 disc level. However note should be made that accounting of the levels on this exam are complicated due to extra vertebral bodies. The signal intensity and caliber of the thoracic cord remains within normal and without evidence of syrinx. There is however evidence of fatty filum terminale extending from approximately L4 inferiorly to the bottom of the thecal sac suggestive of tethered cord.There is lack of any detectable anterior movement of the conus or cauda equina on prone sagittal T2-weighted images when compared to the supine sagittal series suggestive of cord tethering.
1.Unremarkable MRI of cervical spine.2.MRI of the thoracic spine demonstrate a right T9 hemivertebrae and with evidence of 2 extra anatomical well-developed vertebral bodies. Significant dextroscoliosis at the level of T9 hemivertebrae is present.3.MRI of lumbosacral spine demonstrate normal signal intensity and anatomical development of the spine without evidence of dysraphism.4.There is however evidence of fatty filum terminale and there is no detectable anterior movement of the conus or the cauda equina on prone sagittal series which are both suggestive of tethered cord.5.Due to extra vertebral bodies precise level of termination of the cord is difficult to assess. However counting from L5-S1 level superiorly (not considering additional vertebral bodies) the cord terminates at L1-L2 disc level.6.Mild dilatation of the bladder with subtle thickening of bladder wall is noted.