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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Radiology

Decoding Your Child's Scans and Reports

At a Glance

Understanding a caudal regression syndrome (CRS) radiology report involves looking at the shape and position of the spinal cord. Key findings include whether the spinal cord is 'blunted' or 'tethered.' A complete CRS workup also requires checking the kidneys, heart, and bladder.

Reading a radiology report can feel like learning a foreign language. However, these documents contain the essential details your medical team uses to plan your child’s care. By understanding a few key terms, you can decode these reports and participate more fully in your child’s treatment journey [1][2].

Key Terms in Your Child’s Report

When you look at an MRI (Magnetic Resonance Imaging) or ultrasound report, you will likely see these specific medical terms:

  • Vertebral Levels: The spine is divided into sections: C (Cervical/neck), T (Thoracic/middle back), L (Lumbar/lower back), and S (Sacral/tailbone). Numbers like “L3” or “S1” refer to specific bones [3][4].
  • Conus Medullaris: This is the very end of the spinal cord. In a typical spine, it tapers to a point around the L1 or L2 level [4][5].
  • Agenesis: This means a part of the body (like a bone) did not form at all [3][6].
  • Dysgenesis: This means a part of the body formed, but it did not form correctly [3].

Decoding Spinal Cord Shapes

In CRS, the shape and position of the spinal cord tell a story about how it developed. Radiologists look for two main patterns:

1. The “Blunted” Conus (Failure of Formation)

In many cases of CRS, the spinal cord ends abruptly in a flat or “blunted” shape [3][7]. This often happens higher up in the back (above the L1 level) [8]. Because it isn’t being stretched, this type usually does not require surgery to “untether” it [8].

2. The “Tethered” Cord (Failure of Regression)

If the cord ends lower than usual (below L3) or looks like it is being pulled tight by a thickened filum terminale (a thin thread at the end of the cord), it is considered “tethered” [8][9]. A tethered cord is “stuck” and can be stretched as your child grows, which may require a neurosurgeon to perform an “untethering” procedure to protect the nerves [8][10].

The “Completeness Checklist”

Because CRS is a multisystem condition, a “complete” workup involves more than just looking at the spine [11][12]. Ensure your child’s care team has evaluated the following:

System What to Check Common Tests
Spine Level of missing bones; shape of spinal cord [3] MRI, X-ray
Kidneys Check for missing or misplaced kidneys [13] Renal Ultrasound
Gastrointestinal Evaluate for rectal openings or severe constipation [14] Physical Exam, Ultrasound
Heart Look for structural heart defects (common in CRS) [15] Echocardiogram
Bladder Check how the bladder stores and empties urine [16] Urodynamics Study

If any of these areas have not been evaluated, ask your doctor if these tests should be scheduled to ensure no part of your child’s health is overlooked [1][11].

Common questions in this guide

What does it mean if my child's spinal cord is tethered?
A tethered cord means the lower end of the spinal cord is pulled tight and stuck in place. As your child grows, this can stretch the nerves. A neurosurgeon may recommend a procedure to untether the cord and protect your child's nerve function.
What does a 'blunted conus' mean on an MRI report?
A blunted conus means the end of the spinal cord stops abruptly in a flat shape, usually higher up in the back. Because it isn't being stretched, this type of spinal cord ending typically does not require surgery.
What is the difference between agenesis and dysgenesis?
Agenesis means a specific body part, such as a spinal bone, did not form at all during development. Dysgenesis means the body part did form, but it developed incorrectly or abnormally.
Why does my child need heart and kidney tests for a spinal condition?
Caudal regression syndrome is a multisystem condition, meaning it can affect more than just the spine. A complete workup includes tests like echocardiograms and renal ultrasounds to ensure the heart, kidneys, bladder, and digestive tract are developing and functioning properly.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does the MRI show my child's conus medullaris ending at a normal level (L1/L2) or lower?
  2. 2.Is the end of the spinal cord described as 'blunted' or 'tethered'?
  3. 3.Can we review the 'vertebral levels' together to see exactly where the spine stops forming?
  4. 4.Has my child had a 'complete workup,' including scans of the heart and kidneys?
  5. 5.Are there any other findings, like a 'syrinx' or 'lipoma,' that we should monitor as my child grows?

Questions For You

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References

References (16)
  1. 1

    Clinical and radiological evaluation of caudal regression syndrome.

    Krishnan V, Jaganathan S, Jayappa S, et al.

    Pediatric radiology 2024; (54(9)):1451-1461 doi:10.1007/s00247-024-05945-1.

    PMID: 38750326
  2. 2

    Cauda equina, conus medullaris and syndromes mimicking sciatic pain: WFNS spine committee recommendations.

    Vaishya S, Pojskic M, Bedi MS, et al.

    World neurosurgery: X 2024; (22()):100274 doi:10.1016/j.wnsx.2024.100274.

    PMID: 38496349
  3. 3

    Caudal Regression Syndrome: A Case Series of a Rare Congenital Anomaly.

    Kumar Y, Gupta N, Hooda K, et al.

    Polish journal of radiology 2017; (82()):188-192 doi:10.12659/PJR.900971.

    PMID: 28439323
  4. 4

    Magnetic Resonance Imaging Observations of the Conus Medullaris in a Korean Population.

    Moon MS, Jeong JH, Kim SJ, et al.

    Asian spine journal 2019; (13(2)):313-317 doi:10.31616/asj.2018.0118.

    PMID: 30567421
  5. 5

    Morphometry of Conus Medullaris in the Saudi Population and Its Clinical Importance.

    Hiware SD, Vallaba Doss CA, Alola HA, et al.

    Cureus 2022; (14(12)):e32279 doi:10.7759/cureus.32279.

    PMID: 36505957
  6. 6

    Fetal Magnetic Resonance Imaging in Association With Antenatal Ultrasound in the Diagnosis of Caudal Dysgenesis: Report of Two Cases.

    Mahmoud MH, Asghar T, Elkammash TH, et al.

    Cureus 2023; (15(2)):e35485 doi:10.7759/cureus.35485.

    PMID: 36999114
  7. 7

    Think of the Conus Medullaris at the Time of Diagnosis of Fetal Sacral Agenesis.

    Mottet N, Martinovic J, Baeza C, et al.

    Fetal diagnosis and therapy 2017; (42(2)):137-143 doi:10.1159/000451080.

    PMID: 27794580
  8. 8

    Caudal Agenesis: Classification Based on the Pathoembryogenesis of the Spinal Cord.

    Shim Y, Kim KH, Kim SK, et al.

    Neurosurgery 2024; (95(5)):1117-1125 doi:10.1227/neu.0000000000002980.

    PMID: 38722172
  9. 9

    Magnetic Resonance Imaging Analysis of Caudal Regression Syndrome and Concomitant Anomalies in Pediatric Patients.

    Boruah DK, Dhingani DD, Achar S, et al.

    Journal of clinical imaging science 2016; (6()):36 doi:10.4103/2156-7514.190892.

    PMID: 27833778
  10. 10

    Aberrant Dorsal Nerve Root as a Concomitant Cause of Spinal Cord Tethering Associated with a Dorsal Type Lipomyelomeningocele in a Child With Caudal Agenesis.

    Baskurt O, Hicdonmez T, Gazioglu MN

    Nigerian journal of clinical practice 2024; (27(4)):537-540 doi:10.4103/njcp.njcp_838_23.

    PMID: 38679779
  11. 11

    Caudal Regression Syndrome (Spinal Thoraco-lumbo-sacro-coccygeal Agenesis).

    Akhaddar A

    World neurosurgery 2020; (142()):301-302 doi:10.1016/j.wneu.2020.07.055.

    PMID: 32683002
  12. 12

    Caudal regression syndrome with diplomyelia (type 2 split cord malformation), tethered cord, syringomyelia, and horse-shoe kidney.

    Demir MK, Toktaş ZO, Yılmaz B, et al.

    The spine journal : official journal of the North American Spine Society 2016; (16(3)):e193-4.

    PMID: 26482981
  13. 13

    A 13-Year-Old Girl with Caudal Regression Syndrome and Distal Vaginal Atresia: A Case Report.

    Hundarova K, Geraldes F, Águas F, Rodrigues Â

    The American journal of case reports 2024; (25()):e942748 doi:10.12659/AJCR.942748.

    PMID: 38374616
  14. 14

    Caudal regression syndrome: Postnatal radiological diagnosis with literature review of 83 cases.

    Qudsieh H, Aborajooh E, Daradkeh A

    Radiology case reports 2022; (17(12)):4636-4641 doi:10.1016/j.radcr.2022.09.037.

    PMID: 36204402
  15. 15

    Caudal Regression Syndrome - a rare congenital disorder: A case report.

    Mehdi SM, Baig U, Zia MH, Iftikhar N

    JPMA. The Journal of the Pakistan Medical Association 2021; (71(12)):2847-2849 doi:10.47391/JPMA.01-499.

    PMID: 35150560
  16. 16

    Continence management in children with severe caudal regression syndrome: role of multidisciplinary team and long-term follow-up.

    Esposito G, Totonelli G, Iacobelli BD, et al.

    Pediatric surgery international 2022; (38(10)):1461-1472 doi:10.1007/s00383-022-05168-1.

    PMID: 35943565

This page explains caudal regression syndrome radiology terminology for educational purposes only. Your child's radiologist, neurosurgeon, and pediatrician are the best sources for interpreting specific scan results.

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