Tethered cervical cord syndrome: A rare entity - a case report and literature review.

Background: Tethered cord syndrome typically occurs in the lumbosacral spine, with rare instances of cervical cord tethering. This case presents the first documented adult female with cervical cord tethering and a dermal sinus tract in Pakistan, an uncommon congenital anomaly typically identified in infancy. Case Description: A 32-year-old female with a history of spina bifida cystica presented with upper back pain, neck pain, and hand paresthesia. Magnetic resonance imaging (MRI) revealed tethering at the cervical spine, with a dermal sinus tract and dorsal meningocele. The patient underwent surgical detethering and excision of the dermal sinus tract under general anesthesia, and postoperative follow-up was conducted to assess neurological recovery. MRI confirmed cervical cord tethering, with associated abnormalities including a dermal sinus tract extending from C1 to D7, and focal syrinx formation. The patient's symptoms improved postsurgery, with no new neurological deficits observed. Conclusion: Cervical tethered cord with a dermal sinus tract is an exceedingly rare condition, particularly in adults. Early diagnosis and surgical intervention can lead to significant improvement, even in the absence of motor deficits. This case highlights the importance of timely management, even in asymptomatic or mildly symptomatic presentations, to prevent long-term neurological damage. Given the prevalence of spinal dysraphisms in South Asia, including Pakistan, raising awareness about congenital spinal anomalies is essential for early detection and intervention.