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PHA 7-year-old boy was brought with progressive difficulty in walking and urinary incontinence. On inspection, a tuft of hair and dimple were noted over the lower back. Neurological examination revealed spasticity, weakness in the lower limbs, and diminished reflexes. MRI spine showed spina bifida occulta with tethered cord syndrome. The child was referred to neurosurgery for surgical release of the tethered cord. Parents were counseled that surgery could halt progression but some deficits may persist. They were educated on the importance of early recognition of cutaneous markers over the spine in infants.
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