Tethered cord syndrome

A neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column

Tethered cord syndrome (TCS) is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. This condition can lead to significant neurological and orthopedic impairments. Tethered cord syndrome is often associated with spina bifida, but it can also occur in individuals without any visible spinal defects.

Pathophysiology

Tethered cord syndrome occurs when the spinal cord is abnormally attached to the tissues around the spine, preventing it from moving freely. This can result in stretching of the spinal cord as the individual grows, leading to damage to the spinal cord and its associated nerves. The most common sites of tethering are at the filum terminale, a fibrous band that extends from the end of the spinal cord, and at the site of a myelomeningocele repair.

Clinical Presentation

The symptoms of tethered cord syndrome can vary widely depending on the severity of the tethering and the age of the patient. Common symptoms include:

• Back pain, especially in the lower back
• Leg pain or weakness
• Changes in bladder and bowel function
• Scoliosis or other spinal deformities
• Foot and leg deformities
• Loss of sensation or abnormal sensations in the legs

Skin manifestation that is classically seen in tethered cord syndrome

Diagnosis

Diagnosis of tethered cord syndrome typically involves a combination of clinical evaluation and imaging studies. Magnetic resonance imaging (MRI) is the most common imaging modality used to visualize the spinal cord and identify any tethering. In some cases, additional tests such as ultrasound or computed tomography (CT) scans may be used.

Treatment

The primary treatment for tethered cord syndrome is surgical intervention to release the tethered spinal cord. The goal of surgery is to free the spinal cord from the abnormal attachments, allowing it to move more freely and reducing the risk of further neurological damage. Postoperative care may include physical therapy and regular follow-up to monitor for any recurrence of symptoms.

Prognosis

The prognosis for individuals with tethered cord syndrome varies depending on the severity of the condition and the timing of treatment. Early diagnosis and surgical intervention can significantly improve outcomes, reducing the risk of permanent neurological damage. However, some individuals may continue to experience symptoms even after treatment.

Related pages

• Spina bifida
• Myelomeningocele
• Neurological disorder
• Spinal cord