Tethered Cord Syndrome

What is it?

Tethered Cord Syndrome (TCS) is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. This condition is most commonly diagnosed in children and adolescents but can also present in adulthood. In TCS, the spinal cord is “tethered” by an inelastic structure which can be due to various factors, including congenital abnormalities (like spina bifida), tumors, scarring from previous surgery, or spinal cord injury. The tethering results in abnormal tension on the spinal cord, leading to various neurological and functional impairments.

Symptoms

The symptoms of TCS can be diverse, reflecting the level of the spinal cord involved and the degree of tension. Common symptoms include:

  • Pain: Chronic back pain, which can also radiate to the legs.
  • Motor and Sensory Deficits: Weakness, numbness, or tingling in the legs or feet.
  • Bladder and Bowel Dysfunction: Difficulty with bladder control or bowel movements, which may lead to frequent urinary tract infections or constipation.
  • Gait Abnormalities: Changes in walking pattern or difficulty with coordination.
  • Musculoskeletal Deformities: Such as scoliosis (curvature of the spine) or foot deformities.

Diagnosis

Diagnosing TCS typically involves:

  • Clinical Evaluation: A thorough medical history and physical examination, focusing on neurological deficits and musculoskeletal abnormalities.
  • Imaging Studies:
  • MRI: The primary diagnostic tool, providing detailed images of the spinal cord, the site of tethering, and associated abnormalities like lipomas or tumors.
  • CT Myelography: Used in cases where MRI is contraindicated or insufficient.

Treatment

Treatment for TCS is primarily surgical, aiming to relieve the tension on the spinal cord:

  • Surgical Detethering: The mainstay of treatment involves releasing the tethering structure to relieve tension on the spinal cord.
  • Management of Associated Conditions: Addressing any accompanying abnormalities, such as repairing associated spinal defects or removing tumors.
  • Symptomatic Management: Post-surgery, patients may require physical therapy to improve motor function and manage bladder and bowel dysfunction.