Tethered cord syndrome in a child with congenital hydronephrosis: A case of lumbosacral lipoma
Suyeon Kim, Daniel Smith, Paul Maloney, Wissam AlburakiIntroduction:
Lumbosacral lipomas are congenital spinal anomalies that can tether the spinal cord and lead to progressive neurological and urological dysfunction, a condition known as tethered cord syndrome (TCS). While TCS is more readily recognized in neonates with associated cutaneous manifestations, delayed presentations may occur when early clinical signs are subtle or absent.
Case Presentation:
We report the case of a delayed presentation of TCS in a child with a history of persistent antenatal hydronephrosis during infancy. The 33-week gestation male was noted to have antenatal hydronephrosis initially detected on his 20-week antenatal ultrasound that persisted postnatally with no symptoms. There was no clear etiology identified on investigations, and the patient was lost to follow-up after mild improvement of hydronephrosis at age two. At age 10, the patient presented with voiding dysfunction in the background of chronic constipation. After 2 months of conservative treatments with osmotic laxatives, the patient presented with acute urinary retention. Investigations revealed severe bilateral hydronephrosis, a trabeculated bladder, and an elevated creatinine. Urodynamic studies were suggestive of a neurogenic bladder and ruled out vesicoureteral reflux, ureterocele, and posterior urethral valves. Magnetic resonance imaging (MRI) subsequently revealed a low-lying conus at L4–L5, tethered by a filum terminale lipoma, consistent with TCS.
Conclusion:
This case highlights the importance of considering spinal pathologies in children with hydronephrosis when it is accompanied by early bladder dysfunction, neurological abnormalities, cutaneous stigmata, or progressive unexplained deterioration. In such cases, consideration of spinal pathologies via spinal ultrasound or MRI may facilitate early diagnosis and help prevent long-term complications.