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Objective:Tethered cord syndrome(TCS)is an incompletely understood disorder that is characterized by symptoms attributable to downward traction of the caudal end of the spinal cord. We describe the clinical features and radiological findings of tethered cord syndrome, and the downward displacement of the hindbrain that mimics Chiari malformation type I(CM-I). Methods:This study comprised 105 patients who met the classical TCS criteria. Posterior cranial fossa size and volume were measured using reconstructed 2D computed tomography scans and magnetic resonance(MR)images. Results were compared to those in 75 year ageand sexmatched healthy control individuals. The relationships of neural and osseus structures at the craniocervical junction and thoracolumbar junction were investigated morphometrically using the MR images. For 47 patients whose symptoms had worsened or whose neurological findings had deteriorated, a section of the filum terminale was performed. Results:CM-I was present in 81 patients with TCS(77%)and 24 patients without CM-I (23%). The incidence of suboccipital headache was 58%, neck pain:55% and dizziness:43%, and nausea/vomiting 42%. The incidence of low back pain was 86%, leg pain:74% and urinary urgency or incontinence:67%. There were no significant differences in the size or volume of the posterior cranial fossa as compared to healthy control individuals. Morphometric measurements demonstrated an elongation of the brain stem(mean 6.4 mm, p<0.001)and a downward displacement of the medulla(mean 7.2 mm, p<0.001). Symptoms and signs which were related to TCS, were improved or resolved in 31 patients(66%), were unchanged in 14 patients(30%), and became worse in 2 patients(4%). Symptoms and signs which were related to CM-I, were improved or resolved in 22 patients(47%), unchanged in 23 patients(49%), and became worse in 2 patients(4%). After the section of filum terminale, morphometric measurements demonstrated reduction of the brain stem length(mean 4.3 mm, p<0.001)and an improvement of downward displacement of the medulla(mean 3.9 mm, p<0.001). Conclusions:TCS appeared to be a unique clinical entity that manifested an elongation and downward displacement of the hindbrain. TCS might occur as a continuum with CM-Iand may be distinguished from generic CM-I by the absence of a small posterior cranial fossa. There was preliminary evidence that section of filum terminale section could reverse a moderate degrees of the symptoms and signs, as well as reduce the elongation and downward displacement of the brain stem. (Received:October 7, 2008;accepted:February 27, 2009)

Tethered Cord Syndrome : Preliminary Report of Clinical Features and Morphometric Analysis on Association of Chiari Malformation Type Ⅰ