True hamartomas of the spinal cord are very rare, and although several have been reported in the literature, there are few detailed radiological and pathological descriptions of the condition. There is also considerable overlap with other entities, the most common being spinal cord teratomas. The authors report the case of a 13-month-old child with a supragluteal sacral dimple who presented with acute neurological deterioration. MRI of the spine revealed a big intramedullary lesion with heterogeneous signal intensity. A near-total resection was performed, and histopathological examination demonstrated findings consistent with a spinal cord hamartoma. The authors believe that careful preoperative evaluation and rigorous pathological examination are mandatory to establish diagnosis and direct further management of cases in which such a lesion is suspected.

T eThered cord syndrome (TCS) may be associated with myelomeningocele, lipomyelomeningocele, and lumbosacral lipoma or fibrolipomatous filum terminale or may be secondary to arachnoiditis or postsurgical scarring following an initial operative approach. Rates of retethering after sectioning a fatty filum terminale are low. 15,16 Retethering may produce neurological symptoms through nerve root traction and ischemia or tension distributed through the spinal cord. 3,4,12 We present a case of simple tethered cord due to a fatty filum terminale with 3 distinct episodes of recurrence, each presenting with fecal incontinence and resolving with operative intervention. At the last procedure, a discrete sacral nerve root was recognized and individual nerve roots were separated from the filum before its eventual complete resection. Symptoms had not returned at the 9-month follow-up. This case represents a unique clinical course and interesting pathophysiology that, to the best of our knowledge, has not been reported. case report History and ExaminationA healthy 4-year-old boy initially presented with severe constipation and abdominal pain concomitant with low-back and leg pain for which he was being managed with bowel regimens without improvement. Magnetic resonance imaging of the spine demonstrated a fatty filum terminale and tethered cord. The patient underwent tethered cord release at another institution, and his symptoms partially improved for 6 months before a recurrence of his initial symptoms. First RecurrenceThe patient's physical therapist noted new mild weakness of the left leg. Magnetic resonance imaging confirmed release of the filum terminale with the lipoma clearly disconnected, and the surgeon declined to reexplore. The child presented to our office at this time for a second opinion. We offered to perform an exploration at the original surgical abbreviatioN TCS = tethered cord syndrome. Recurrent manifestations of tethered spinal cord after an initial operative intervention for a simple fatty filum terminale is fairly uncommon. The authors present the case of an unusual clinical course in which there were 3 distinct episodes of recurrence, each time presenting predominantly as fecal incontinence and resolving with operative intervention. Typical signs of tethering were absent on radiological evaluation, and operative intervention was based on clinical grounds. Intraoperatively, sacral nerve roots to the anal sphincter were found tethered to the filar stump with electrophysiological evidence of regained activity on disentanglement. To the best of the authors' knowledge, a similar clinical course or operative findings have not been reported.