The diagnosis of tethered spinal cord by MRI in seven children with cutaneous lumbar hemangioma is reported from the Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine. The hemangiomas ranged in size from 4 × 6 cm to 8 × 20 cm and all overlapped the midline. All demonstrated tethered cords; four showed intraspinal lipomas, and two showed tight fila terminale. At surgery, all infants were found to have tethered cords and none had an intraspinal hemangioma. All patients were neurologically normal both pre and postoperatively. 
COMMENT. The lumbar hemangiomas in these patients were large and the significance of small lesions is not known. Despite a normal neurological examination, infants or children with large lumbar cutaneous hemangiomas should be suspected of having tethered cords and magnetic resonance imaging should be obtained. If neurologic deficits are allowed to develop with increasing age, the likelihood of postoperative improvement is only 25-50%. Ultrasound may be used to diagnose tethered cords but magnetic resonance is usually required for better visualization. In addition to the association with cutaneous hemangioma, tethered cord occurs with subcutaneous lipoma, a hairy tuft, a prominent dimple, or a midline sinus tract or skin defect.