Is There a Correlation between the position of conus medullaris and the clinical presentation and surgical outcomes in primary tethered cord Syndrome?

Adult tethered-cord syndrome (TCS) is a controversial subject. Clinical presentation and radiographic diagnosis do not always corelate, resulting in the diagnosis being incorrectly dismissed. We reviewed the clinical presentation and surgical outcome with regards to the position of the conus medullaris using a prospectively maintained database of patients treated by single neurosurgeon between 9/1/2019 to 12/31/2021. The position of the conus medullaris was determined from the T-2 weighted sagittal and axial MRI images and designated as being above, at or below the L1/L2 disc space. Prevalence of signs, symptoms, intra-operative findings and outcomes were compared. In 101 patients reviewed, the conus was located above, at or below the L1/L2 disc in 32, 30 and 39 patients respectively. The male/female ratio and duration of symptoms did not differ between the groups. The groups did not differ with regards to the prevalence of low back pain, paresthesiae or pain in the lower extremities, subjective weakness in the lower extremities, urinary symptoms or bowel motility symptoms. Surgery, prescribed based on clinical signs and symptoms, consisted of sacral laminectomy and sectioning of the filum terminale interna. Near complete resolution of symptoms was achieved in 75 patients, independently of the position of the conus medullaris. The diagnosis of the TCS should be considered in the differential diagnosis of patients presenting with lower back and leg pain accompanied by urological symptoms.