What is tethered spinal cord syndrome?

Tethered spinal cord syndrome is a congenital malformation characterised by scar tissue that fixes the spinal cord to the dura (the soft tissue membrane surrounding it), preventing the normal flow of spinal fluid around the cord and the normal movement of the fluid within the membrane. This tethering (fixation) causes cysts to appear.

Tethered spinal cord syndrome is usually diagnosed in childhood although some people show symptoms in adulthood.

Prognosis of the disease

If the tethered spinal cord is treated surgically, the prognosis is good, although the outcome will be less favourable the later the surgery is performed.

Symptoms of tethered spinal cord

Some of the symptoms of tethered spinal cord are:

• Back and leg pain
• Difficulty standing 
• Deformity, weakness, or numbness in the feet
• Faecal and/or urinary incontinence
• Changes in spinal or foot growth
• Worsening of scoliosis

These symptoms often occur gradually during growth spurts or during growth hormone treatment for short stature.

Medical tests for tethered spinal cord

The following tests may be performed to confirm the diagnosis of a tethered spinal cord:

• CT scan
• MRI scan
• X-ray
• Ultrasound of the spinal cord
• Muscle examination
• Kidney and bladder tests

What are the causes of tethered spinal cord?

Tethered spinal cord is a pathology that is present from birth and is caused by the abnormal development of the spine during pregnancy. It is sometimes related to other pathologies such as spina bifida and Chiari malformations.

Can it be prevented?

Tethered spinal cord cannot be prevented as such, but it can be treated to prevent it from recurring.

Treatment for tethered spinal cord

Tethered spinal cord is treated with surgery, which removes the scar tissue from around the spinal cord in order to restore fluid flow and movement to the spinal cord. A graft is also placed to strengthen the dural space and reduce the risk of scar tissue forming again. If cysts have formed, a tube or shunt is inserted to drain the fluid from the cysts.

While most children will need only one untethering procedure, some may require a further procedure. The neurosurgeon will decide when and how to perform the surgery.

After the surgery

After surgery, the patient will have to sleep for about 5 days flat on their back, face down or on their side. After this time, they will be able to sit up and get out of bed. If all goes well, they will then be discharged and will have a follow-up visit within 7-10 days.