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Medullary Cone Movement in Subjects with a Normal Spinal Cord and in Patients with a Tethered Spinal Cord1

Theodoor D. Witkamp, MD, William P. Vandertop, MD, PhD, Frederik J. A. Beek, MD, PhD, Nicolette C. Notermans, MD, PhD, Robert H. J. M. Gooskens, MD, PhD and Paul F. G. M. van Waes, MD, PhD

1 From the Departments of Radiology (T.D.W., F.J.A.B., P.F.G.M.v.W.), Neuromuscular Diseases (N.C.N.), and Child Neurology (R.H.J.M.G.), University Hospital Utrecht, HPnr: E.01.132, Heidelberglaan 100, NL-3584 CX Utrecht, the Netherlands; and the Department of Neurosurgery, Free University Amsterdam, the Netherlands (W.P.V.). Received December 9, 1999; revision requested January 24, 2000; revision received December 13; accepted January 15, 2001. Address correspondence to T.D.W. (e-mail: j.m.m.vanamstel@azu.nl).



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  		Figure 1a. Drawings show the measurements made on (a) supine and (b) prone MR images. The vertical black structure at the top of the drawing is the spinal cord and medullary cone. Ap = distance between the medullary cone and the ventral dura at MR imaging with the patient in the prone position, As = distance between the medullary cone and the ventral dura at MR imaging with the patient in the supine position, W = width of dural sac at the level of the tip of the medullary cone. Percentage of movement = (As - Ap)/(W x 100).

 


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  		Figure 1b. Drawings show the measurements made on (a) supine and (b) prone MR images. The vertical black structure at the top of the drawing is the spinal cord and medullary cone. Ap = distance between the medullary cone and the ventral dura at MR imaging with the patient in the prone position, As = distance between the medullary cone and the ventral dura at MR imaging with the patient in the supine position, W = width of dural sac at the level of the tip of the medullary cone. Percentage of movement = (As - Ap)/(W x 100).

 


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  		Figure 2a. Spin-echo MR images (500/20) of the lumbar spine obtained in a healthy volunteer in the (a) supine and (b) prone positions. Distinct movement (33%) of the medullary cone (c) is visible.

 


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  		Figure 2b. Spin-echo MR images (500/20) of the lumbar spine obtained in a healthy volunteer in the (a) supine and (b) prone positions. Distinct movement (33%) of the medullary cone (c) is visible.

 


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  		Figure 3. Scatterplot shows the variation in range of movement among the three subject groups. All patients are included, and one square dot may represent more than one patient. 1 = healthy volunteers, 2 = patients clinically suspected of having a tethered cord, 3 = patients previously operated on for a tethered spinal cord.

 


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  		Figure 4a. Spin-echo (a) supine and (b) prone MR images (500/20) of the lumbar spine obtained in a patient clinically suspected of having a tethered cord. The supine MR image is normal, whereas the prone image shows only slight (11%) medullary cone (c) movement. A tethered spinal cord was found at surgery.

 


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  		Figure 4b. Spin-echo (a) supine and (b) prone MR images (500/20) of the lumbar spine obtained in a patient clinically suspected of having a tethered cord. The supine MR image is normal, whereas the prone image shows only slight (11%) medullary cone (c) movement. A tethered spinal cord was found at surgery.

 


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  		Figure 5a. Spin-echo (a) supine and (b) prone MR images (500/20) of the lumbar spine obtained in a patient with a tethered cord due to a lipomatous thickened terminal filum. No medullary cone movement is visible. The arrowheads point to the stretched spinal cord and medullary cone.

 


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  		Figure 5b. Spin-echo (a) supine and (b) prone MR images (500/20) of the lumbar spine obtained in a patient with a tethered cord due to a lipomatous thickened terminal filum. No medullary cone movement is visible. The arrowheads point to the stretched spinal cord and medullary cone.

 




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