Disclosures: Vera M. Staley, MD: No financial relationships or conflicts of interest

Case Description: A healthy man fell ten feet while working, but was able to stand and continue working. He developed worsening low back and leg pain, asymmetric leg weakness, and difficulty urinating. Upon admission to an acute care hospital, an MRI of the spine showed bilateral foraminal stenosis at L4/5 without cord signal changes and a small syrinx at T10/11. There was no surgical intervention and he was discharged to an acute rehabilitation hospital. His physical exam revealed a T11 ISNCSCI A spinal cord injury with motor sparing through S1. The differential diagnosis for his symptoms included infectious causes including osteomyelitis, epidural abscess, sarcoidosis, tuberculosis, syphilis; vascular causes including AV malformation and infarction; epidural mass; and peripheral lesions including nerve root compression, neurogenic vasculitis, or chronic inflammatory demyelinating polyneuropathy. Workup did not reveal any of these causes. A CT myelogram revealed ventral displacement of the thoracic spinal cord, suggestive of tethered cord. The patient underwent a T4-T9 laminectomy and untethering and the diagnosis of tethered cord was confirmed.

Setting: Acute rehabilitation hospital.

Patient: A 43-year-old man with acute paraplegia. Assessment/

Results: Following untethering surgery, this patient regained significant function with return of independent bowel and bladder function and improvement in lower extremity sensation and motor function, achieving community ambulation with 2 crutches for stability. His postoperative course was complicated by a right leg deep vein thrombosis extending up to an IVC filter. He also developed a hemorrhagic pseudomeningocele in the surgical bed which resolved without surgical intervention.

Discussion: This case represents a rare cause of spinal cord injury with the very subtle imaging findings of syrinx and ventral-lying cord to suggest the diagnosis of a tethered spinal cord. Early recognition and treatment of the tethered cord can lead to significant recovery.

Conclusion: It is important to consider tethered cord as a potential cause of spinal cord injury.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/untethering-surgical-intervention-leads-to-significant-motor-and-sensory-recovery-in-a-patient-with-complete-paraplegia-due-to-unknown-cause-a-case-report/