Tethered Cord Syndrome

What Is It?

Tethered cord syndrome refers to a group of neurological disorders that cause part of the spinal cord to be abnormally attached to other tissues in the spine. Like spina bifida, it most commonly results from an abnormality of development of the tail end of the nervous system. This abnormal attachment puts traction on the spinal cord, which can cause symptoms or even permanent damage to the spinal cord.

The underlying cause of a tethered cord is not always known, although it can be associated with various types of spinal dysraphism, or abnormalities of spinal cord development. In these disorders, the spinal cord and its surrounding tissues (including the meninges, the coverings of the central nervous system, bone and soft tissues) do not develop normally due to problems with neural tube formation. The neural tube is the tissue in the embryo that forms all of the central nervous system. If these tissues form in such a way that attaches to the spinal cord, it can lead to tethering as the individual grows.

In addition to tethered cord associated with abnormal development, some individuals can develop a tethered cord later in life due to scar tissue that forms after a spinal injury or surgery.

What Types of Symptoms Are Typical?

Depending on the location and severity of tethering, tethered cord can present differently. In those who developed the condition in early development, it most commonly presents itself in childhood and can be progressively severe as the patient grows in stature, putting further tension on the spinal cord.

Symptoms can include back pain, weakness and sensory abnormalities in the legs, and incontinence. In addition to these symptoms, some patients may have a "stigmata" of spinal dysraphism on their back, such as various lesions on the middle of the lower back. These can include patches of hair, dimples, a sinus tract or even fatty tumors (lipoma) in the area that can be visible on the skin surface overlying the area.

Less commonly, tethered cord syndrome can present itself later in life if too much strain is placed on the area of tethering, which may be brought on by strenuous sports, for example.

How Is The Diagnosis Typically Made?

In a patient with symptoms suggestive of cord tethering, an imaging study such as a spinal MRI may be performed to identify any anatomical abnormalities that may indicate tethering. Any lesion found in that area which is associated with symptoms of tension on the spinal cord can lead to a diagnosis of a tethered cord.

What Are Some Common Treatments?

In children with symptoms, early surgery is generally recommended to reduce the risk for further, and potentially permanent, injury to the spinal cord which could occur with activity and growth. Various types of surgery may be used, depending on the underlying anatomy and lesion, to attempt to reduce or eliminate the tethering and therefore reverse symptoms and prevent progression.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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