Tethered Spinal Cord Syndrome: Symptoms, Causes, Treatment

What are the symptoms of tethered spinal cord syndrome?

Tethered spinal cord syndrome is a condition in which the spinal cord is abnormally attached to the surrounding tissues, causing it to become stretched or pulled. Symptoms can vary depending on the severity of the tethering and the age of the individual. Common symptoms include:

• Back Pain: Persistent or worsening pain in the lower back or sacral area.
• Leg Pain and Weakness: Pain, weakness, or cramping in the legs. This can affect mobility and balance.
• Neurological Symptoms: Numbness or tingling in the legs or feet, which may be due to nerve compression or damage.
• Scoliosis: Abnormal curvature of the spine, which can develop or worsen over time.
• Bladder and Bowel Issues: Difficulty with bladder control (e.g., urinary incontinence or retention) and bowel problems (e.g., constipation or incontinence).
• Foot Deformities: Abnormalities such as clubfoot or other foot deformities.
• Skin Changes: Changes in the skin over the lower back, such as a dimple, hemangioma, or pigmented lesion.
• Muscle Spasms: Involuntary muscle contractions or spasms in the lower body.
• Gait Abnormalities: Difficulty walking or an abnormal gait due to weakness or pain.
• Sensory Changes: Decreased or altered sensation in the lower limbs.
• Progressive Symptoms: In some cases, symptoms may worsen gradually over time, affecting overall function and quality of life.

Symptoms can vary widely depending on the extent of spinal cord tethering and the age at which it is diagnosed. Early diagnosis and treatment are important to manage symptoms and prevent further neurological damage.

What are the causes of tethered spinal cord syndrome?

Tethered spinal cord syndrome is caused by abnormal attachment or fixation of the spinal cord to the surrounding structures, which leads to stretching or pulling of the spinal cord. The causes can be congenital (present at birth) or acquired. Common causes include:

• Congenital Causes:
• Spina Bifida: A condition where the spinal column does not fully close during fetal development, leading to a tethered spinal cord. This is often associated with spina bifida occulta, where a defect in the bony encasement of the spinal cord allows abnormal attachment.
• Arnold-Chiari Malformation: A condition where the brainstem and cerebellum are displaced downward into the spinal canal, which can cause the spinal cord to become tethered.
• Dermal Sinus Tract: A congenital defect where a tract or cyst connected to the skin can tether the spinal cord.
• Acquired Causes:
• Surgical Scarring: Scar tissue from previous spinal surgery can cause abnormal adhesion and tethering of the spinal cord.
• Trauma: Spinal cord injuries from accidents or trauma can lead to scar formation or tissue changes that tether the spinal cord.
• Tumors: Benign or malignant tumors in the spinal cord or adjacent structures can cause tethering by creating adhesions or directly attaching to the spinal cord.
• Infections: Infections of the spine or spinal cord that lead to abscesses or other complications can result in tethered spinal cord syndrome.
• Inflammatory Conditions: Conditions that cause chronic inflammation or formation of fibrous tissue around the spinal cord can contribute to tethering.

Tethered spinal cord syndrome is often diagnosed through imaging studies such as MRI, which can help identify the extent and cause of tethering. Treatment typically involves surgical intervention to release the tethered spinal cord and prevent further neurological damage.

What is the treatment for tethered spinal cord syndrome?

Treatment for tethered spinal cord syndrome typically involves surgical intervention to relieve the tension on the spinal cord and address the underlying cause of the tethering. The specific treatment approach can vary based on the severity of the condition and the individual’s overall health. Here are the key aspects of treatment:

• Surgical Release: The primary treatment is surgery to untether the spinal cord. This involves removing or releasing any abnormal attachments, scar tissue, or tumors that are causing the spinal cord to become tethered. The goal is to alleviate pressure and prevent further neurological damage.
• Preoperative Evaluation: Before surgery, a thorough evaluation, including imaging studies like MRI, is performed to assess the extent of the tethering and plan the surgical approach.
• Postoperative Care: After surgery, careful monitoring and follow-up care are essential. This includes managing pain, preventing infection, and monitoring for any changes in neurological function.
• Rehabilitation: Physical therapy and rehabilitation may be recommended to help improve mobility, strength, and function following surgery. This can aid in recovery and enhance overall quality of life.
• Management of Symptoms: For individuals with symptoms such as pain, weakness, or bladder and bowel issues, supportive treatments and medications may be used to manage these symptoms.
• Regular Follow-up: Regular follow-up with a healthcare provider is important to monitor for any recurrence of symptoms or complications and to ensure continued recovery and improvement.

Early diagnosis and intervention are crucial for optimal outcomes. If you suspect tethered spinal cord syndrome or have symptoms consistent with it, seeking prompt medical evaluation and treatment is important to prevent long-term complications.