What is Tethered Cord Syndrome?

 

Tethered spinal cord syndrome is a neurological disorder caused by tissue adhesions that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord / limit the free movement of cord within the canal. The course of the disorder is progressive.

 

What are the symptoms of Tethered Cord Syndrome?

 

In children, symptoms may include:

• Hairy patches over spine, esp. lower part
• Dimples, or fatty tumours on the lower back,
• Foot and spinal deformities,
• Weakness in the legs,
• Low back pain,
• Scoliosis(abnormal curvature of spine)
• Incontinence (to urine or stool)

 

Tethered spinal cord syndrome may go undiagnosed until adulthood, when sensory and motor problems and loss of bowel and bladder control emerge. Tethered spinal cord syndrome appears to be the result of improper growth of the neural tube during fetal development.

 

How is it diagnosed?

MRI is effective in identifying Teethered cord.

 

Why does it develop?

It is a congenital disease. Where terminal portion of the spinal cord become fixed with the bony cage and disproportionate growth between the two causes it.

 

How is it treated?

To prevent additional neurological degeneration in children, surgery should be performed as soon as possible. Surgery to liberate (detether) the spinal cord in adults can lessen the degree of damage to cord as well as restore some function and relieve other symptoms. Other treatment is symptomatic and supportive.

 

Are there any alternatives?

After the diagnosis of tethered cord syndrome, surgery maybe mandatory. However, other modality of treatment like physiotherapy, yoga, exercise, etc. don’t cure or alter the disease and its process, but have supportive role in easing the symptoms

 

What will happen if it is left untreated?

If left untreated, the neurological symptoms and deficits will progress over the period of time. The progression occurs in months and in some cases, years. There can be sudden neurological deficit in cases of trauma or sports activities involving forward bending. Damages caused in such cases are usually irreversible

 

How to prepare for surgery?

All elective neurological cases are advised to be fasting overnight. You should follow the given instructions and take the prescribed medicines before sleeping.

• Don’t consume water without consulting your doctor
• Take a shower before the surgery

 

What are the surgery plans?

Tethered cord syndrome may either be due to standalone issues like thickened filum terminal or associated with other defects like meningocoele, split cord malformation etc.

 

Depending on the disease, it may be planned to just release the cord ( like cutting of the thickend filum) or treat the associate defect as a whole.

 

What are the risks of surgery?

While majority of patients have an uneventful surgery and recovery, a few cases may have complications. These are less frequent and not all the ones listed below are applicable to one individual. However, it is important that you are aware of the complications that may arise out of this procedure:

• Infection
• Bleeding which may warrant anotherprocedure
• CSF leak
• Inadequate removal of the lesion
• Worsening of the existing neurological deficit or development of fresh deficit

 

When to contact doctor after surgery?

The patient should contact the doctor in case of any:

• Any new abnormal sensations
• Any infection on surgical wound site
• Any injury on the back
• Worsening of pre existing symptoms
• Difficulty in passing stool / urine after the surgery