From the Guidelines
The most common skin abnormalities associated with tethered cord syndrome on the lumbar sacral spine include hypertrichosis, infantile hemangioma, atretic meningocele, subcutaneous lipoma, and caudal appendage, as these are considered high-risk cutaneous markers for underlying spinal dysraphism. These cutaneous markers are important clinical indicators that should prompt further investigation for tethered cord, as they often occur directly over the site of the underlying spinal abnormality 1. The presence of these markers is explained by the embryological relationship between skin and neural tissue development, as both derive from ectoderm. During normal development, the neural tube separates from the cutaneous ectoderm, but abnormalities in this separation process can result in both the tethering of the spinal cord and the associated skin manifestations.
Some key points to consider when evaluating these skin abnormalities include:
- Hypertrichosis refers to a focal tuft of hair of variable thickness located in the posterior spinal midline, and is often accompanied by a capillary hemangioma and may be associated with dimples or subcutaneous masses 1.
- Infantile hemangiomas that are midline and overlie the spine, particularly in the lumbar region, are associated with spinal and genital urinary malformations in up to 55% of cases as part of the LUMBAR syndrome 1.
- Atretic meningocele is another high-risk cutaneous marker that is associated with underlying spinal dysraphism 1.
- Subcutaneous lipoma and caudal appendage are also considered high-risk cutaneous markers for underlying spinal dysraphism 1.
When these skin findings are identified, especially in infants or children with neurological symptoms, prompt neuroimaging with MRI is recommended to evaluate for tethered cord, as early surgical intervention can prevent progressive neurological deterioration 1.
From the Research
Skin Abnormalities Associated with Tethered Cord
The most common skin abnormalities on the lumbar sacral spine associated with tethered cord include:
- Dimples
- Sinus tracts
- Hypertrichosis
- Capillary hemangiomas 2 These skin abnormalities are often associated with occult spinal dysraphism, which can lead to the development of tethered cord syndrome.
Types of Skin Abnormalities
Different studies have reported various types of skin abnormalities associated with tethered cord, including:
- Lipoma in the lumbosacral region
- Dermal sinus
- Cutaneous hemangioma
- Hypertrichosis 2, 3 These skin abnormalities can be a sign of an underlying spinal cord anomaly, such as a lipomyelomeningocele or a diastematomyelia.
Clinical Presentation
The clinical presentation of tethered cord syndrome can vary, but common symptoms include: