Tethered spinal cord syndrome (TSCS) is a neurological condition in which the spinal cord is abnormally stretched or anchored, often causing mechanical stress on the spinal cord and nerve roots. Over time, this tension can lead to pain, neurological deficits, and functional impairments.
Tethered Spinal Cord Definition and Pathophysiology
Tethered spinal cord occurs when the spinal cord is fixed to surrounding structures such as fibrous bands, lipomas, or scar tissue, limiting its normal movement. This abnormal tension can:
Reduce blood flow within the cord.
Stretch nerve roots.
Increase metabolic stress.
Cause progressive neurological dysfunction.
Common associated conditions:
Spina bifida and lipomeningocele
Dermal sinus tracts.
Fibrotic or adherent dura.
Postoperative scar tissue, particularly after spina bifida surgery.
Epidemiology
TSCS can affect both children and adults, with early childhood and adolescence being the most common periods for diagnosis.
Both males and females are equally affected.
Although rare, early diagnosis and intervention are critical for preserving neurological function.
Symptoms
Symptoms depend on age and the degree of spinal cord tension:
In Children
Difficulty walking and lower limb weakness.
Foot deformities, such as pes cavus or scoliosis.
Bladder and bowel control issues.
Chronic back or lumbar pain.
In Adults
Persistent lower back and leg pain.
Neurogenic claudication, causing leg weakness or discomfort during walking.
Bladder and bowel dysfunction
Muscle weakness and sensory deficits.
Spinal deformities, including scoliosis.
Diagnosis and Evaluation
Accurate diagnosis of TSCS requires detailed clinical assessment and advanced imaging.
1. Clinical Examination
Detailed motor and reflex testing.
Sensory evaluation for light touch, pain, and proprioception.
Assessment of gait and posture.
Bladder and bowel function evaluation.
2. Tethered Spinal Cord Radiology
Magnetic Resonance Imaging (MRI): Tethered spinal cord MRI: High-resolution visualization of spinal cord position (especially conus is locate at L2 and below), structural abnormalities, and areas of tethering.
Ultrasound: Dynamic assessment of tethering, particularly in neonates and infants.
Computed Tomography (CT): Detects bony anomalies, spina bifida, or scoliosis.
3. Electrophysiological Testing
Nerve conduction studies and electromyography to assess lower limb nerve and muscle function.
Treatment
The primary goals of treatment for tethered spinal cord are to release tension microsurgically on the spinal cord, preserve neurological function, and reduce pain.
1. Surgical Treatment
Surgery is the most effective intervention for patients with:
Progressive pain and neurological symptoms.
Bladder or bowel dysfunction.
Lower limb weakness or deformities.
Untethering/Detethering surgery: Removal of fibrotic bands, lipomas, or adherent tissues to free the spinal cord.
2. Conservative Management
Observation and monitoring for patients with mild or stable symptoms.
Pain management using NSAIDs or other analgesics.
Regular neurological follow-up.