Tethered Spinal Cord Syndrome
Tethered spinal cord syndrome is a neurologic disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column.
These attachments cause an abnormal stretching of the spinal cord. This syndrome is closely associated with spina bifida.
It is estimated that 20-50% of children with spina bifida defects that are repaired shortly after birth will require surgery at some point to untether the spinal cord.
Myelomeningocele/Lipomyelomeningoce
The lower tip of the spinal cord is normally located opposite the disc between the first and second lumbar vertebrae in the upper part of the lower back. In people with spina bifida (myelomeningocele), the spinal cord fails to separate from the skin of the back during development, preventing the spinal cord from ascending normally; therefore, the spinal cord is low-lying, or tethered. In patients with a lipomyelomeningocele, the spinal cord will have fat at the lower tip, and this fat may connect to the fat that overlies the thecal sac (a fluid filled sac that the spinal cord “floats” within) that may also lead to thethering.
Although the skin is separated and closed at birth, the spinal cord stays in the same location after the closure. As a child continues to grow, the spinal cord can become stretched, causing damage and interfering with the blood supply to the spinal cord.
Primary Causes and Symptoms
In addition to myelomeningocele and lipomyelomeningocele discussed above, the following are other causes of tethered cord that vary in severity of symptoms and treatment:
- Dermal sinus tract (a rare congenital deformity).
- Diastematomyelia (split spinal cord).
- Lipoma (a benign, fatty growth).
- Tumor
- Thickened/tight filum terminale (a delicate filament near the tailbone)
- A history of spine trauma.
- A history of spine surgery.
Symptoms in Children
The symptoms listed below are some of the ways in which tethered spinal cord syndrome may be exhibited in children:
- Lesion on the lower back.
- Fatty tumor or deep dimple on the lower back.
- Skin discoloration on the lower back.
- Hairy patch on the lower back.
- Back pain, worsened by activity and relieved with rest.
- Leg pain, especially in the back of legs.
- Leg numbness or tingling.
- Changes in leg strength.
- Deterioration in gait.
- Progressive or repeated muscle contractions.
- Leg deformities.
- Spine tenderness.
- Scoliosis (curvature of the spine).
- Bowel and bladder problems.
Although it is rare, a patient with tethered spinal cord can continue undiagnosed into adulthood. In such cases, the strain on the spinal cord increases, leading to increasing sensory and motor problems, as well as loss of bladder and bowel control.
Emergency Cases
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