Some researchers, noting that less severe spinal cord traction may remain asymptomatic in childhood, hypothesize that the age of symptom onset is related to the amount of cord stretch. 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. Common symptoms include The child usually can resume normal activities within a few weeks. Background: Tethered cord syndrome is a well-defined condition, the management of which is fairly uniform. Up and Down arrows will open main level menus and toggle through sub tier links. Signs and symptoms of a tethered cord can include the following: A crooked toe. Complications include infection, bleeding, and damage to the spinal cord or myelomeningocele, which may result in decreased muscle strength or bladder or bowel function. Recovery of lost muscle and bladder function depends upon the degree and length of preoperative implications. Untethering is generally performed only if clinical signs or symptoms of deterioration are observed. Surgery in adult patients with a tethered cord syndrome should be reserved for those with symptoms. Patients may present with any combination of the following 4: 1. Children may have several symptoms of tethered spinal cord, including: Back pain or shooting pain in the legs Weakness, numbness or problems with muscle function in the legs Left and right arrows move across top level links and expand / close menus in sub levels. Tethered cord syndrome is a clinical diagnosis based on neurologic deterioration involving the lower spinal cord 7. When Tethering of Spinal Cord occurs in children it causes the spinal cord to stretch abnormally as the child grows, but in adults the spinal cord stretches with any activity the individual does which may be at work or at home. Sometimes, symptoms appear in middle age, as deterioration of the spinal cord begins after many years of tethering. A lesion, skin discoloration, or hairy patch on the lower back may be an indication that a problem may exist below the skin. 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. In adults, symptoms of tethered cord usually develop slowly. Tethered cord is one of the conditions treated by the specialists at the Weill Cornell Chiari CARE program. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon” online tool. The pathophysiology is unclear and may be conceptually incongruent with current understanding of typical tethered cord syndrome. Bladder dysfunction, in particular, is common. (Photo 5) Needles are inserted into the lower body to monitor nerve function even as the child is asleep. As a result, the spinal cord can’t move freely within the spinal canal. Infants and children with congenital tethered cord syndrome may also have tufts of hair, dimples, skin discoloration, or benign fatty tumors on the lower back. 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. Tab will move on to the next part of the site rather than go through menu items. © 2021 American Association of Neurological Surgeons. Trouble with bowel or bladder control, such as difficulty in toilet training in a toddler, keeping a dry diaper with a baby, loosing control in a toilet trained child or no being able to hold urine until getting to the bathroom. Tethered cord syndrome may not result in any symptoms early in life, but may become problematic later due to age-related changes in the spine, resulting in: 1. In children, symptoms may include lesions, hairy patches, dimples, or fatty tumors on the lower back; foot and spinal deformities; weakness in the legs; low back pain; scoliosis; and incontinence. The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. These attachments cause an abnormal stretching of the spinal cord. loss of bladder or bowel control. Once the myelomeningocele is freed from all scarred attachments, the dura and the wound are closed. If a tethered cord is found, imaging with an MRI is usually done to gain more detailed information about the spinal cord. At times we use a laser to sharply dissect tissue from the nerves. In addition to myelomeningocele and lipomyelomeningocele discussed above, the following are other causes of tethered cord that vary in severity of symptoms and treatment: The symptoms listed below are some of the ways in which tethered spinal cord syndrome may be exhibited in children: Although it is rare, a patient with tethered spinal cord can continue undiagnosed into adulthood. This situation may require additional surgery. (Photo 1) A dimple above the gluteal crease (the crease in the buttocks) (Photo 2) Long hair (longer than 1 inch) growing on the back over the spine. Common symptoms include back pain, leg pain, constipation, urinary dysfunction (urgency, frequency, accidents or recurrent urinary infections), foot deformities and scoliosis. The course of the disorder is progressive. Baltimore. All Rights Reserved, background-image - a woman looking at a screen, Neurosurgery Research & Education Foundation, Dermal sinus tract (a rare congenital deformity), Thickened/tight filum terminale (a delicate filament near the tailbone), Fatty tumor or deep dimple on the lower back, Back pain, worsened by activity and relieved with rest, Progressive or repeated muscle contractions. This condition is called a tethered spinal cord. 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. Tethered Cord Syndrome is a condition where the spinal cord is abnormally attached within the bony spine causing stretching and tugging that can be painful and lead to disability. A tethered spinal cord occurs when the spinal cord is attached to tissue around the spine, most commonly at the base of the spine. You could see a weak foot or foot deformity, delayed walking, bowel issues or back pain in older kids. This information is provided as an educational service and is not intended to serve as medical advice. However, another aspect of that diagram to the right is that some believe that a tethered cord can also pull on the brain and cause it to hang low in the skull base, intersecting with a disease called “Chiari Malformation”. However, because symptoms of tethering can occur during periods of growth, 10-20% of children with this syndrome require repeated surgery. (Photo 3), A crooked crease between the buttocks. Tethered cord syndrome, lipomeningomyelocele, or meningomyelocele, includes a group of congenital diseases,( which child is born with) may include swelling in the midline of the lower back of the spine, filled with CSF ( brain water and nerves), or this may be containing fat entangling the nerves meant to supply the lower limbs. Symptoms can worsen during periods of rapid growth, as the tethered cord becomes more stretched. Learn more about the NREF and make a donation today. Omar Zalatimo, MD MPH MHA FAANS Tethered cord syndrome refers to a group of neurological disorders that relate to malformations of the After some time, follow-up with the neurosurgeon may be on an as needed basis or if symptoms return. Releasing the tethering lesion; can be simple or highly complex requiring many hours or dissection under the microscope. Many children require only one untethering procedure. The images below show the lesion before it is cut (left), the lesion after it is cut (center), and the lesion released (right). No menu assigned! Back pain, worsened by activity and relieved with rest. The site navigation utilizes arrow, enter, escape, and space bar key commands. Tethered cord syndrome occurs when tissue attachments limit the movement of the spinal cord … In contrast, occult tethered cord syndrome is a recently defined entity, where the management is still controversial. Although the skin is separated and closed at birth, the spinal cord stays in the same location after the closure. The spinal cord is wrapped in a covering, or sheath, that allows bones and tissues to expand during childhood and adolescence. « Back to Glossary IndexBACK PAIN: Lower back pain, especially when standing, walking or being active PROBLEMS WITH EXTREMITIES: Leg pain Numbness in lower legs/feet (tingling/pins-and-needles sensation) Gait Disturbance History of growing pains History of heel or toe walking as a child High arches INCONTINENCE ISSUES: Urinary Dysfunction Urgency Frequency … The spinal cord typically divides into small nerve roots at the L2 vertebral body. Some children with tethered spinal cord are not identified in infancy. weakness or numbness in the legs or feet. On rare occasions, years after the original surgery, a re-tether may develop for certain types of tethered cords causing radiating leg pain, persistent back pain or bladder problems. Sometimes a small portion of the bony vertebrae (laminae) are removed to obtain better exposure or to decompress the spinal cord. The spinal cord includes the bundle of nerves that controls leg movement and sensation as well as bladder function. Typical symptoms are: Lower back pain; Leg pain; Muscle weakness, manifesting in toes and legs; Urinary incontinence or urinary retention; Fecal incontinence or chronic constipation; Foot, leg and spinal deformities; Symptoms usually exacerbate over time. Tethered Cord What is ‘tethered cord’? 17 tethered cord syndrome patients report severe fatigue (32%) 23 tethered cord syndrome patients report moderate fatigue (43%) 10 tethered cord syndrome patients report mild fatigue (18%) 3 tethered cord syndrome patients report no fatigue (5%) A child with tethered spinal cord syndrome will usually develop symptoms. problems standing or walking. Clinically, tethered cord syndrome usually presents with slowly progressive lower extremity weakness, lower extremity or back pain, scoliosis, gait abnormalities, and/or changes in bowel/bladder function, reflexes, foot-shape, or leg length. If they have surgery as soon as possible after tethered cord and bladder symptoms appear, they have a better chance of recovery and less of a … (Photo 3) A crooked crease between the buttocks. Sometimes the tissue prevents the normal development of the spinal cord so that there are problems with urination and leg weakness. As a child continues to grow, the spinal cord can become stretched, causing damage and interfering with the blood supply to the spinal cord. A conservative … This syndrome is closely associated with spina bifida. There shall be difficulty in the bowel control. … An incision is made in the skin over the lower back, Lifting up of the bone over the tethered area of the spinal cord (, Making a small opening in the covering of the spinal cord, called the. “Occult tethered cord” Symptoms consistent with tethered cord (as reviewed) and exclusion of other conditions and co-morbidities No imaging evidence of fatty or thickened filum and conus at “normal” position Essentially, a normal standard MRI
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