In tethered cord syndrome, the spinal cord is abnormally attached to surrounding tissues, causing a variety of neurological symptoms. Symptoms, causes, diagnosis, treatment, and prevention of tethered cord syndrome are explained in this article.
Causes:
There are several factors that can cause tethered cord syndrome, including:
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Tethered cord syndrome can be caused by congenital anomalies, such as spina bifida or myelomeningocele.
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Trauma to the spine or spinal cord can result in scarring or adhesions, tethering the spinal cord.
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The spinal cord can be tethered and stretched by benign or malignant tumors in the surrounding tissues.
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The spinal cord can become tethered following previous spinal surgery, particularly when tumors are removed or deformities are corrected.
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After surgery, infection, or inflammation, scar tissue can tether the spinal cord and impair its function.
Symptoms:
The symptoms of tethered cord syndrome vary depending on the severity of the tethering and the age of onset, but may include:
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A persistent or recurrent pain in the lower back, buttocks, or legs, typically after prolonged sitting or standing.
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Having difficulty moving the legs, feet, or toes, particularly when walking, climbing stairs, or lifting objects.
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Numbness, tingling, or loss of sensation in the legs, feet, or genital region.
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Incontinence, urinary or fecal incontinence, or recurrent urinary tract infections are symptoms of bladder or bowel dysfunction.
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Walking abnormalities include dragging the feet, walking on tiptoes, or tripping frequently.
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In individuals with tethered cord syndrome, particularly those with congenital anomalies, scoliosis, kyphosis, or other spinal deformities may occur.
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If left untreated, progressive weakness, paralysis, or loss of motor function in the lower extremities can result.
Diagnosis:
The diagnosis of tethered cord syndrome usually involves a combination of clinical evaluation, medical history, and diagnostic tests. Diagnostic procedures might include:
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During a physical examination, a healthcare provider will assess neurological function, muscle strength, reflexes, and sensation in the lower extremities, as well as examine any spinal abnormalities.
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MRI or CT scans are used to visualize the spinal cord and surrounding structures, assess for signs of tethering, compression, or abnormalities, and rule out other conditions.
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Studies of electrophysiology: Nerve function can be assessed with electromyography (EMG) or nerve conduction studies.
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Individuals with symptoms of bladder dysfunction may undergo urodynamic testing, such as uroflowmetry or cystometry, to assess bladder capacity, detrusor function, and urinary sphincter control.
Treatment:
Tethered cord syndrome treatment aims to relieve symptoms, prevent neurological deficits from progressing, and preserve or improve quality of life. Treatment options include:
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Surgically untethering the spinal cord, also known as tethered cord release or detethering, may be recommended to release adhesions, remove tumors, or correct spinal deformities.
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Tethered cord syndrome may be treated with medications such as pain relievers, muscle relaxants, or antispasmodics to relieve pain, muscle spasms, or bladder and bowel dysfunction.
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Individuals with tethered cord syndrome can benefit from rehabilitation exercises, stretching, and strengthening programs supervised by a physical therapist.
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Individuals with severe neurological deficits may benefit from assistive devices such as braces, orthotics, or mobility aids.
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Regular follow-up appointments with healthcare providers, such as neurologists, orthopedic surgeons, and urologists, are essential to monitoring symptoms, assessing treatment response, and detecting disease progression.
Prevention:
Individuals can take steps to reduce their risk and minimize complications of tethered cord syndrome, including:
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Regular prenatal care and screening during pregnancy can help identify and manage tethered cord syndrome-associated congenital anomalies or fetal abnormalities.
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Preventing spinal injuries: Wearing protective gear during sports or activities that may pose a fall or accident risk can help reduce the risk of tethered cord syndrome.
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Symptoms of spinal cord injury, infection, or inflammation should be evaluated and treated promptly to prevent the progression of tethered cord syndrome.
