Tethered spinal cord syndrome is a neurological disorder. This disorder is caused by tissue attachments that restrict motion of the spinal cord within the spinal column. These attachments create an unusual lengthening of the spinal cord. A tethered spinal cord is related to spina bifida. Children with spina bifida problems (20-50%) may need a surgery to untether the spinal cord at some point in their life.
Myelomeningocele/Lipomyelomeningocele
On a normal spinal cord, the lower tip is usually opposite of the disc between the first and second lumbar vertebrae in the upper part of the low back. The spinal cord does not properly separate from the skin of the back during development in people with myelomeningocele, spina bifida. This causes the spinal cord to hang unusually and the spinal cord is tethered. People with lipomyelomeningocele have fat at the lower end of the spinal cord. This fat could connect with the fat that lies over the thecal sac and can cause tethering.
The spinal cord will stay in the same location despite the skin being separated and closed at birth. As children grow, the spinal cord can get stretched and cause damage. This damage can interfere with blood supply to the spinal cord.
PRIMARY CAUSES AND SYMPTOMS
Here are more causes of a tethered spinal cord:
- Dermal sinus tract (a rare congenital deformity)
- Diastematomyelia (split spinal cord)
- Lipoma (benign, fatty growth)
- Tumor
- Thickened or tight filum terminale (delicate filament near tailbone)
- History of trauma to the spine
- History of spinal surgery
Symptoms in children
- Lesion on the lower back
- Fatty tumor in the lower back
- Discoloration of skin on the lower back
- Hairy patches on the lower back
- Back pain that increases with activity and decreases with rest
- Leg pain (back of legs)
- Leg numbness and tingling
- Altered leg strength
- Deterioration in gait
- Muscle contractions
- Leg deformities
- Spine tenderness
- Scoliosis
- Bowel and bladder issues
A tethered spinal cord could go untreated and undiagnosed until late in life. When this happens, the stress on the spinal cord can continue to get worse causing sensory and motor issues as loss of control of bladder or bowels.
DIAGNOSIS
There are the following tests that may be needed:
- MRI
- CT or CAT scan
- Myelogram
- Ultrasound
SURGERY
If there are symptoms of deterioration, unthreatening may become an option of treatment. This surgery opens the scar from the closure down to the covering over the myelomeningocele. It is possible that small portions of vertebrae must be removed to have better exposure or to decompress the spinal cord. After the myelomeningocele is freed from the scarred attachments, the wound and the covering over the myelomeningocele are closed.
A few weeks post surgery, a child can go back to daily activities. Depending on the preoperative conditions, muscle and bladder control will vary post operation. This surgery has a complication rate of around 1-2%. Some of the common complications include infection, bleeding, spinal cord damage, damage to the myelomeningocele, decrease in muscle strength, loss of bladder or bowel control. Usually only one untethering surgery will be needed but 10-20% of children may need a repeated surgery as they grow.
FOLLOW UP
A patient will need to follow up with their neurosurgeon and usually do physical therapy.
