From the Guidelines
Tethered spinal cord syndrome is a neurological disorder characterized by the abnormal attachment of the spinal cord to surrounding tissues, leading to limited movement within the spinal canal and potential neurological symptoms. This condition can occur congenitally or be acquired later in life due to various factors such as spinal surgery, trauma, or inflammation 1. The clinical manifestations of spinal cord tethering are age-dependent, with infants often being asymptomatic, while older children and adults may experience symptoms such as pain, sensorimotor disturbances, and difficulties with bladder and/or bowel control 1.
Key Characteristics
- Abnormal attachment of the spinal cord to surrounding tissues
- Limited movement within the spinal canal
- Potential neurological symptoms, including back pain, leg weakness or numbness, and bladder or bowel dysfunction
- Congenital or acquired condition
- Diagnosis typically involves MRI imaging to visualize the tethering
Clinical Manifestations
- Infants: often asymptomatic, with malformations recognized by associated cutaneous abnormalities
- Older children: symptoms may include pain, sensorimotor disturbances, and difficulties with bladder and/or bowel control
- Adults: may experience sudden appearance of new pain and/or neurologic deficits after sudden back stretching, such as during childbirth or vigorous sporting activities 1
Treatment and Prevention
Early detection and treatment are crucial for preventing progressive neurological deterioration, as the stretching of the spinal cord can damage nerve cells and disrupt normal function over time 1. Treatment usually requires neurosurgical intervention to release the tethered cord, ideally before permanent neurological damage occurs.
From the Research
Definition and Characteristics of Tethered Spinal Cord
- Tethered cord syndrome is associated with motor and sensory deficits 2
- It is defined by abnormal traction on the spinal cord that confines its movement 3
- The syndrome is characterized by symptoms and signs caused by excessive tension on the spinal cord 4
- Tethered cord syndrome can present in any age group, with pain, cutaneous signs, orthopedic deformities, and neurological deficits being the most common presentations 4
Diagnosis of Tethered Spinal Cord
- MRI is the imaging modality of choice for diagnosing tethered cord syndrome, with moderate strength of evidence for its diagnostic accuracy 2
- Conus level has the highest diagnostic accuracy and inter-reader reliability in tethered cord syndrome 3
- Prone and cine MRI do not add to the accuracy of supine imaging 3
Treatment and Outcomes of Tethered Spinal Cord
- Surgical untethering is indicated in patients with progressive or new onset symptomatology attributable to tethered cord syndrome 4
- Early operative intervention is associated with improved outcomes, including pain relief and stabilization of neurological function 4
- Surgical detethering can improve neurologic status, but also carries risks of postoperative complications such as cerebrospinal fluid leakage 2
- A novel biportal endoscopic approach has been described as a minimally invasive technique for tethered cord release, with successful outcomes and rapid postoperative recovery 5
Clinical Presentation and Misdiagnosis
- Tethered cord syndrome in adults can be misdiagnosed, with a triad of nondermatomal sacral or perineal pain, bladder dysfunction, and neurological deficit that should not be confused with hip or degenerative lumbosacral disease 6
- Adults with newly diagnosed tethered cord syndrome often have unrecognized neurocutaneous abnormalities and neurological deficits 6