A 67 year-old man presented with a life long history of bladder urgency and a 5 year history of progressive weakness and numbness of the lower extremities, worse on the left. His gait had become unsteady.

The spinal cord in adults normally terminates at the caudal level of the L1 vertebral body. A tethered spinal cord occurs when the cord becomes abnormally attached to tissue within the spinal canal, rather than floating free. This results in abnormal stretching of the spinal cord below the L1 vertebral body over time. It is more common in certain congenital disorders including myelomeningocele, lipoma or lipomyelomeningocele, diastematomyelia, dermal sinus tract, or tight filum terminale. The typical presentation is that of a slowly progressive myelopathy much like a syrinx, manifesting as a progressive gait abnormality (spastic or wide-based gait), weakness of the legs, sensory loss, and incontinence of bowel and bladder. Patients with symptomatic tethered cords often present with orthopedic deformities, including pes varus, valgus, or cavus; recurrent hip dislocations; or rotational abnormalities of an extremity or extremities. An isolated presentation of scoliosis is not uncommon.