Tethered Cord Syndrome With Abnormal Gait

Maritza DeLaRosa, MD, Vasantha Kondamudi, MD, Noah Kondamudi, MD, Sham Juratli, MD


J Am Board Fam Med. 2003;16(4) 

In This Article


Parents frequently visit their family physicians with concerns of gait abnormality in their children. Minor musculoskeletal anomalies and normal age-related gait variation are the most frequent causes. Tethered cord syndrome is an uncommon pathologic entity that can be initially asymptomatic and subsequently manifest serious neurological sequelae. Prognosis depends on early recognition and prompt surgical correction for optimal outcome. We describe a case of a previously healthy 17-month-old child with abnormal gait who had tethered cord syndrome.

A 2-year-old boy was brought to our Family Practice Center with the complaint of abnormal walk for the past 6 months. He had been getting his health maintenance at our center since birth. His great grandmother first expressed concern about the way he walked at age 17 months, but no abnormality was detected at that time. There were no other associated symptoms, including injury, fever, headaches, or weakness.

The prenatal history was remarkable for a maternal second-trimester chlamydial cervicitis that was treated with azithromycin. The child was born at 35 weeks' gestation by spontaneous vaginal delivery to a 21-year-old mother, para 1,1,1,2. The postnatal period was uncomplicated.

His medical history was notable for a second-degree facial burn at 8 months of age. Social services excluded the possibility of child neglect. He was also evaluated for failure to thrive (height and weight less than 10th percentile) at age 1 year despite apparent good nutrition. At that time there were no serious pathologic findings found on his initial medical workup.

His immunizations were up-to-date, his developmental milestones were normal, and there was no family history of gait or feet abnormalities.

He was a thinly built (height and weight remained at less than the 10th percentile), active child with normal temperature and blood. Respiratory and cardiovascular findings were unremarkable. He had lumbar levoscoliosis, overlapping toes, and increased joint laxity caused by possible hypotonia. He had equal length of both extremities, full range of motion, and good ankle dorsiflexion. There were no sacral dimples, tags, nevi, lipomas, or hypertrichosis. He had normal cranial nerves, normal sensory system, normal power (grade 5), normal tone and reflexes, and good coordination. Genitourinary and rectal findings were normal. His gait was characterized by elevation of the left shoulder and left hip with normal stance and balance. A complete blood count and chemistry profile were normal.

Radiographs of the spine and pelvis showed L4 hemivertebra with sharp levoscoliosis. Spinal magnetic resonance imaging showed low-lying conus medullaris at L3, L4 hemivertebra with associated levoscoliosis. There were no intraspinal masses or lipomas. Findings of a renal sonogram and a voiding cystourethrogram were normal.

The pediatric neurologist confirmed the above findings and noted generalized hypotonia. The chromosomal analysis was normal. Operative findings confirmed a low-lying conus medullaris with stretching of the nerve roots. A thickened fatty filum terminale was also found, which was coagulated and cut, along with release of the tethered spinal cord.

The postoperative course was uneventful and the child at a 1-year follow-up examination had a completely normal gait.