{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:12:59Z","timestamp":1772827979248,"version":"3.50.1"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The relationship between Chiari malformation type I (CMI) and tethered cord syndrome (TCS) is not well understood. The aim of this study was to examine conus position and rates of TCS and tethered cord release (TCR) in pediatric patients with CMI at a tertiary hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The medical records of children with a diagnosis of CMI based on MRI of the lumbar spine from 2010 to 2023 were retrospectively reviewed. Conus position on MRI, tonsil position below the foramen magnum, presence of fatty filum or filum terminale lipoma, and rates of CMI decompression and TCR were recorded. Age- and sex-matched controls were randomly selected from a cohort of patients who obtained an MRI of the spine for any reason. Conus position was coded and then compared using the Student t-test. Categorical variables were compared using the chi-square test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 657 pediatric patients with CMI were included. The mean \u00b1 SD tonsil position was 11.7 \u00b1 5.6 mm below the foramen magnum, and 44.7% of patients underwent CMI decompression. The conus terminated at or above the L2\u20133 disc space in 97% of CMI patients. There was no statistical difference in conus position between CMI patients and controls (p = 0.09). Nine patients (1.4%) in the CMI cohort had symptomatic TCS and underwent TCR. This proportion was not statistically different compared to the control group: 11 patients (1.7%) had symptomatic TCS and underwent TCR (p = 0.1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Most patients with CMI had a normal conus position (97%), and conus position was not different between CMI and control patients. The number of patients with symptomatic TCS was not statistically different between CMI and control patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.5.peds24551","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T02:04:33Z","timestamp":1759543473000},"page":"689-693","source":"Crossref","is-referenced-by-count":0,"title":["No increased incidence of tethered cord syndrome or low-lying conus in pediatric Chiari malformation type I"],"prefix":"10.3171","volume":"36","author":[{"given":"Katherine G.","family":"Holste","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Abor, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"McVeigh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Abor, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Albdewi","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugh J. L.","family":"Garton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Abor, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cormac O.","family":"Maher","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin M.","family":"Muraszko","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Abor, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neena I.","family":"Marupudi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Abor, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Surg Neurol","first-page":"20","article-title":"Association of Chiari malformation type I and tethered cord syndrome: preliminary results of sectioning filum terminale","volume":"72","author":"Milhorat TH","year":"2009","unstructured":"Milhorat TH, Bolognese PA, Nishikawa M,  Association of Chiari malformation type I and tethered cord syndrome: preliminary results of sectioning filum terminale. Surg Neurol. 2009;72(1):20\u201335."},{"issue":"1","key":"b2","series-title":"J Spine Surg","first-page":"45","article-title":"Developments in the treatment of Chiari type 1 malformations over the past decade","volume":"4","author":"Passias PG","year":"2018","unstructured":"Passias PG, Pyne A, Horn SR,  Developments in the treatment of Chiari type 1 malformations over the past decade. J Spine Surg. 2018;4(1):45\u201354."},{"issue":"Suppl 3","key":"b3","series-title":"Neurol Sci","first-page":"S353","article-title":"Tethered cord: natural history, surgical outcome and risk for Chiari malformation 1 (CM1): a review of 110 detethering","volume":"32 Suppl 3","author":"Valentini LG","year":"2011","unstructured":"Valentini LG, Selvaggio G, Visintini S, Erbetta A, Scaioli V, Solero CL. Tethered cord: natural history, surgical outcome and risk for Chiari malformation 1 (CM1): a review of 110 detethering. Neurol Sci. 2011;32 Suppl 3(Suppl 3):S353\u2013S356."},{"key":"b4","series-title":"J Clin Neurosci","first-page":"165","article-title":"Chiari malformation clusters describe differing presence of concurrent anomalies based on Chiari type","volume":"58","author":"Horn SR","year":"2018","unstructured":"Horn SR, Shepard N, Vasquez-Montes D,  Chiari malformation clusters describe differing presence of concurrent anomalies based on Chiari type. J Clin Neurosci. 2018;58:165\u2013171."},{"issue":"11","key":"b5","series-title":"J Clin Neurosci","first-page":"1749","article-title":"Spinal cord detethering in children with tethered cord syndrome and Chiari type 1 malformations","volume":"22","author":"Glenn C","year":"2015","unstructured":"Glenn C, Cheema AA, Safavi\u2013Abbasi S, Gross NL, Martin MD, Mapstone TB. Spinal cord detethering in children with tethered cord syndrome and Chiari type 1 malformations. 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Complex chiari malformations: diagnosis, evaluation, and treatment. Neurosurg Clin N Am. 2023;34(1):143\u2013150."},{"issue":"1","key":"b17","series-title":"Neurosurg Focus","first-page":"e3","article-title":"Spinal lipomas","volume":"10","author":"Blount JP","year":"2001","unstructured":"Blount JP, Elton S. Spinal lipomas. Neurosurg Focus. 2001;10(1):e3."},{"issue":"2","key":"b18","series-title":"AJNR","first-page":"259","article-title":"MR imaging determination of the location of the normal conus medullaris throughout childhood","volume":"10","author":"Wilson DA","year":"1989","unstructured":"Wilson DA, Prince JR. MR imaging determination of the location of the normal conus medullaris throughout childhood. AJNR. 1989;10(2):259\u2013262."},{"issue":"1","key":"b19","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Tethered cord syndrome: a review of the literature from embryology to adult presentation","volume":"29","author":"Hertzler DA","year":"2010","unstructured":"Hertzler DA, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2010;29(1):E1."},{"issue":"5","key":"b20","series-title":"Pediatr Neurosurg","first-page":"249","article-title":"The position of the conus medullaris in children with a Chiari I malformation","volume":"33","author":"Tubbs RS","year":"2000","unstructured":"Tubbs RS, Elton S, Bartolucci AA, Grabb P, Oakes WJ. The position of the conus medullaris in children with a Chiari I malformation. Pediatr Neurosurg. 2000;33(5):249\u2013251."},{"issue":"7","key":"b21","series-title":"Acta Neurochir (Wien)","first-page":"1117","article-title":"Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management","volume":"152","author":"Milhorat TH","year":"2010","unstructured":"Milhorat TH, Nishikawa M, Kula RW, Dlugacz YD. Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management. Acta Neurochir (Wien). 2010;152(7):1117\u20131127."},{"issue":"3 Suppl","key":"b22","series-title":"J Neurosurg","first-page":"196","article-title":"Critical analysis of the Chiari malformation Type I found in children with lipomyelomeningocele","volume":"106","author":"Tubbs RS","year":"2007","unstructured":"Tubbs RS, Bui CJ, Rice WC,  Critical analysis of the Chiari malformation Type I found in children with lipomyelomeningocele. J Neurosurg. 2007;106(3 Suppl):196\u2013200."},{"issue":"5 Suppl","key":"b23","series-title":"J Neurosurg","first-page":"309","article-title":"Occult tethered cord syndrome: a survey of practice patterns","volume":"104","author":"Steinbok P","year":"2006","unstructured":"Steinbok P, Garton HJ, Gupta N. Occult tethered cord syndrome: a survey of practice patterns. J Neurosurg. 2006;104(5 Suppl):309\u2013313."},{"issue":"2","key":"b24","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Minimal tethered cord syndrome: what\u2019s necessary to justify a new surgical indication?","volume":"23","author":"Selden NR","year":"2007","unstructured":"Selden NR. Minimal tethered cord syndrome: what\u2019s necessary to justify a new surgical indication? Neurosurg Focus. 2007;23(2):E1."},{"issue":"1","key":"b1","series-title":"Surg Neurol","first-page":"20","article-title":"Association of Chiari malformation type I and tethered cord syndrome: preliminary results of sectioning filum terminale","volume":"72","author":"Milhorat TH","year":"2009","unstructured":"Milhorat TH, Bolognese PA, Nishikawa M,  Association of Chiari malformation type I and tethered cord syndrome: preliminary results of sectioning filum terminale. Surg Neurol. 2009;72(1):20\u201335."},{"issue":"1","key":"b2","series-title":"J Spine Surg","first-page":"45","article-title":"Developments in the treatment of Chiari type 1 malformations over the past decade","volume":"4","author":"Passias PG","year":"2018","unstructured":"Passias PG, Pyne A, Horn SR,  Developments in the treatment of Chiari type 1 malformations over the past decade. J Spine Surg. 2018;4(1):45\u201354."},{"issue":"Suppl 3","key":"b3","series-title":"Neurol Sci","first-page":"S353","article-title":"Tethered cord: natural history, surgical outcome and risk for Chiari malformation 1 (CM1): a review of 110 detethering","volume":"32 Suppl 3","author":"Valentini LG","year":"2011","unstructured":"Valentini LG, Selvaggio G, Visintini S, Erbetta A, Scaioli V, Solero CL. Tethered cord: natural history, surgical outcome and risk for Chiari malformation 1 (CM1): a review of 110 detethering. Neurol Sci. 2011;32 Suppl 3(Suppl 3):S353\u2013S356."},{"key":"b4","series-title":"J Clin Neurosci","first-page":"165","article-title":"Chiari malformation clusters describe differing presence of concurrent anomalies based on Chiari type","volume":"58","author":"Horn SR","year":"2018","unstructured":"Horn SR, Shepard N, Vasquez-Montes D,  Chiari malformation clusters describe differing presence of concurrent anomalies based on Chiari type. J Clin Neurosci. 2018;58:165\u2013171."},{"issue":"11","key":"b5","series-title":"J Clin Neurosci","first-page":"1749","article-title":"Spinal cord detethering in children with tethered cord syndrome and Chiari type 1 malformations","volume":"22","author":"Glenn C","year":"2015","unstructured":"Glenn C, Cheema AA, Safavi\u2013Abbasi S, Gross NL, Martin MD, Mapstone TB. Spinal cord detethering in children with tethered cord syndrome and Chiari type 1 malformations. J Clin Neurosci. 2015;22(11):1749\u20131752."},{"issue":"2","key":"b6","series-title":"Arch NeurPsych","first-page":"328","article-title":"Arnold-Chiari malformation and its operative treatment","volume":"40","author":"Penfield W","year":"1938","unstructured":"Penfield W, Coburn DF. Arnold-Chiari malformation and its operative treatment. 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J Neurosurg Pediatr. 2011;8(2):205\u2013213."},{"issue":"1","key":"b10","series-title":"Ann Ist Super Sanita","first-page":"48","article-title":"Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort","volume":"56","author":"Ciaramitaro P","year":"2020","unstructured":"Ciaramitaro P, Garbossa D, Peretta P,  Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort. Ann Ist Super Sanita. 2020;56(1):48\u201358."},{"issue":"3","key":"b11","series-title":"Pediatr Neurosurg","first-page":"236","article-title":"Tethered cord syndrome: an updated review","volume":"43","author":"Lew SM","year":"2007","unstructured":"Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. 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Neurosurg Focus. 2007;23(2):E7."},{"issue":"3","key":"b14","series-title":"Neurol Sci","first-page":"S345","article-title":"The complex Chiari: issues and management strategies","volume":"32 Suppl 3","author":"Brockmeyer DL","year":"2011","unstructured":"Brockmeyer DL. The complex Chiari: issues and management strategies. Neurol Sci. 2011;32 Suppl 3(3):S345\u2013S347."},{"issue":"5","key":"b15","series-title":"J Neurosurg Spine","first-page":"619","article-title":"Chiari malformation and syringomyelia","volume":"31","author":"Holly LT","year":"2019","unstructured":"Holly LT, Batzdorf U. Chiari malformation and syringomyelia. J Neurosurg Spine. 2019;31(5):619\u2013628."},{"issue":"1","key":"b16","series-title":"Neurosurg Clin N Am","first-page":"143","article-title":"Complex chiari malformations: diagnosis, evaluation, and treatment","volume":"34","author":"Ravindra VM","year":"2023","unstructured":"Ravindra VM, Brockmeyer DL. Complex chiari malformations: diagnosis, evaluation, and treatment. Neurosurg Clin N Am. 2023;34(1):143\u2013150."},{"issue":"1","key":"b17","series-title":"Neurosurg Focus","first-page":"e3","article-title":"Spinal lipomas","volume":"10","author":"Blount JP","year":"2001","unstructured":"Blount JP, Elton S. Spinal lipomas. Neurosurg Focus. 2001;10(1):e3."},{"issue":"2","key":"b18","series-title":"AJNR","first-page":"259","article-title":"MR imaging determination of the location of the normal conus medullaris throughout childhood","volume":"10","author":"Wilson DA","year":"1989","unstructured":"Wilson DA, Prince JR. MR imaging determination of the location of the normal conus medullaris throughout childhood. AJNR. 1989;10(2):259\u2013262."},{"issue":"1","key":"b19","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Tethered cord syndrome: a review of the literature from embryology to adult presentation","volume":"29","author":"Hertzler DA","year":"2010","unstructured":"Hertzler DA, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2010;29(1):E1."},{"issue":"5","key":"b20","series-title":"Pediatr Neurosurg","first-page":"249","article-title":"The position of the conus medullaris in children with a Chiari I malformation","volume":"33","author":"Tubbs RS","year":"2000","unstructured":"Tubbs RS, Elton S, Bartolucci AA, Grabb P, Oakes WJ. The position of the conus medullaris in children with a Chiari I malformation. 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J Neurosurg. 2007;106(3 Suppl):196\u2013200."},{"issue":"5 Suppl","key":"b23","series-title":"J Neurosurg","first-page":"309","article-title":"Occult tethered cord syndrome: a survey of practice patterns","volume":"104","author":"Steinbok P","year":"2006","unstructured":"Steinbok P, Garton HJ, Gupta N. Occult tethered cord syndrome: a survey of practice patterns. J Neurosurg. 2006;104(5 Suppl):309\u2013313."},{"issue":"2","key":"b24","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Minimal tethered cord syndrome: what\u2019s necessary to justify a new surgical indication?","volume":"23","author":"Selden NR","year":"2007","unstructured":"Selden NR. Minimal tethered cord syndrome: what\u2019s necessary to justify a new surgical indication? 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