Tethered Spinal Cord: Causes, Symptoms, Treatment, Diagnosis

Tethered Spinal Cord is a pathological condition in which the spinal cord which is normally freely hanging structure which can move about freely and goes up and down becomes attached or joined to the spinal column through the surrounding structures. When this happens the spinal cord is not able to move freely and is trapped tightly at one end thus reducing flow of blood to the spinal nerves and damaging the spinal cord due to excessive stretching and reduced blood flow to nerves. Tethered Spinal Cord or Tethering of Spinal Cord can occur before the baby is born or after birth. It can even occur in adults. This occurs most commonly in the lower part of the spine. Tethered Spinal Cord is in almost all cases accompanied by a condition called as spina bifida. When Tethering of Spinal Cord occurs in children it causes the spinal cord to stretch abnormally as the child grows, but in adults the spinal cord stretches with any activity the individual does which may be at work or at home. If Tethered Spinal Cord is left untreated it can cause permanent damage to the spinal cord.

When talking of children there may be many reasons for Tethering of Spinal Cord, but in majority of cases this occurs with a condition called myelomeningocele which is quite an uncommon birth defect. With time as the child grows, the spinal cord becomes stuck at one place and tethering of the spinal cord occurs. As a result of this, there is pressure exerted on the spinal cord resulting in quite bothersome symptoms. Some of the other reasons for Tethered Spinal Cord in children are medical condition like filum terminale in which the endpoint of the spinal cord becomes abnormally tight, there is an abnormal tract going into the spinal canal from skin, a condition called as diplomyelia in which the spinal cord gets divided into two parts at its end, and lastly if the child has a tumor of the spine.

Some of the symptoms of Tethered Spinal Cord or Tethering of Spinal Cord are:

• Severe lower back and leg pain
• Deformities of the feet and spine
• Weakness of the lower extremities
• Tethering of spinal cord can lead to development of scoliosis
• Bladder and bowel control problems are also a symptoms of Tethered Spinal Cord.

Apart from these symptoms there may also be certain other abnormalities like a dimple or a birthmark or other anorectal malformations. As stated if this condition is left untreated it can cause severe damage to the spinal cord.

Majority of the cases of Tethered Spinal Cord or Tethering of Spinal Cord are caught in their early phases quite easily due to the deformities that present with it in the back like fatty masses, areas of increased pigmentation, abnormally large collection of hair. As soon as such abnormalities are observed it is best to seek a consultation with a physician who will order an MRI scan which can clearly confirm the diagnosis of Tethering of Spinal Cord. In an infant, an MRI may not be recommended and an ultrasound may be done to confirm this condition. It is always recommended to image the spine in its entirety and just not the part which is having the symptoms in order to rule out other conditions causing the symptoms.

The best way to treat Tethered Spinal Cord or Tethering of Spinal Cord is to correct it surgically. For this, the neurosurgeon will recommend a procedure called as laminectomy. In this procedure, the surgeon will remove some part of the bones in the spine in order to reach the spinal cord and the nerve roots. Once this is done, the next step is to release the spinal cord from its attached fatty tissue by gently cutting it. This is done very carefully in order to avoid injuring the adjacent neural structures and nerve roots. Once the spinal cord is free, the surgeon will then patch it up to prevent CSF leakage. This procedure can also be termed as untethering of the spinal cord. Even after a successful procedure there is a 30% chance of recurrence of this condition as the child grows and repeated untethering may be required.

Below mentioned are some of the questions that are asked quite frequently regarding Tethered Spinal Cord. These questions are:

The answer to this is that various forms of alternative therapies and physical therapy have been tried, but they have provided only temporary relief and in the long term the symptoms more often than not return, hence as of now surgical treatment is the only effective treatment for Tethering of Spinal Cord.

Usually untethering of the spinal cord is considered a safe procedure with very minimal risk, but as with any surgical procedure there are inherent risks with this procedure as well and include risks of infection, bleeding, damage to adjacent neurovascular structures, worsening of the condition, worsening of bladder and bowel function, but these risks are considered to be very rare.

Yes. There is always a chance that the spinal cord may tether again as and when the child grows hence the child may require frequent untethering as long as the child is in growing years.