Tethered Spinal Cord Syndrome

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What is tethered cord?

Tethered spinal cord syndrome, or tethered cord, is a condition in which
your spinal cord becomes attached to your spine. The most common site
for attachment, or tethering, is in the lumbar spine.
Normally, your spinal cord floats in a cushion of cerebrospinal fluid at
the centre of your spinal column. This allows it to move freely as you
bend, stretch, and move and also protects it from stress as the bones of
your spinal column change with age. There are many conditions that can
cause or are associated with a tethered cord including:
Chiari malformations, where the brain extends into the top of the
spinal canal
Spina bifida, or structural defects of the lower spinal cord
Trauma or injury to your lower back resulting in spinal cord injury
Scar tissue from surgery
Tumors or cysts in and around your spinal cord

How common is tethered cord and what are the risk

factors?
Tethered cord can happen in both children and adults. Approximately 2 of
every 1,000 people are born with a tethered cord, but as mentioned above,
sometimes tethered cord develops as a result of non-congenital factors like
scar tissue or the growth of tumors or cysts in your spinal cord.

What are the symptoms of tethered cord?

The symptoms of tethered cord can vary widely. In addition, symptoms in
children are often different than those that appear in adults. Symptoms in
children can include:
lesions, fatty tumors, hair growth, dimples, or skin discoloration on the
lower back
pain in the legs or lower back
difficulty walking
bedwetting or urinary accidents
deformities in the legs and feet

Symptoms are detectable by the age of four in 70% of children. Your

childs symptoms will almost always worsen as they grow, and some
neurological deficits may not be reversible.
In adults, these symptoms are similar but may be more severe due to
growth putting more tension on the spinal cord over time.

How is tethered cord diagnosed?

If tethered cord is suspected, magnetic resonance imaging (MRI) will be
used to view your lower spinal cord and verify that it is attached to the
surrounding structures.

What are the treatments for tethered cord?

If your tethered cord is causing only mild symptoms or no symptoms at all, your
doctor may recommend observation over surgery. However, surgery may be
indicated with even mild symptoms, as neurological function that has been lost
may not return even after surgery to free your tethered cord.
For severe cases, the only chance for symptom relief is through surgery. This
involves opening the lower back to expose the abnormality that is pinning or
attaching the spinal cord to its surrounding structures. Neurosurgeons typically
detach your spinal cord from its surrounding structures using delicate surgical
techniques, often working under a powerful microscope.

In cases where the spinal cord becomes tethered again after your initial surgery,
the surgery to can be repeated. Alternatively, a surgery can be performed to
remove a vertebra from your spine. This shortens your spine and can diminish
the tension on your stretched spinal cord and provide symptom relief. This
procedure is typically reserved for patients with multiple surgeries in the past
for tethered cord syndrome.

What is the prognosis for tethered cord?

Surgery to release a tethered cord can stop your symptoms from getting
worse and may relieve pain and other symptoms that are not purely
neurological. However, any symptoms like leg weakness and numbness
that result from nerve damage are likely irreversible. Repeat tethering
of the spinal cord may occur in some patients, and often the return of
symptoms is a sign of repeat tethering. As mentioned above, alternative
surgeries could be considered in these circumstances.