Tethered Cord Syndrome
Tethered cord syndrome occurs when the spinal cord is abnormally attached within the spinal canal, limiting its normal movement as a child grows. The resulting tension can affect the nerves that control the legs, bladder, bowel, and other functions.
Quick Answer
Tethered cord syndrome occurs when the spinal cord is fixed or attached within the spinal canal instead of moving freely. As a child grows, this can place increasing tension on the spinal cord and nerves. Some children can be monitored, while progressive neurological symptoms may lead to surgical untethering.
Key Takeaways
- Tethered cord places abnormal tension on the spinal cord as a child grows.
- Symptoms can include back or leg pain, weakness, walking changes, scoliosis, and bladder or bowel dysfunction.
- Skin findings over the lower back may provide an early clue in some children.
- MRI is the primary imaging study used to evaluate the spinal cord and surrounding anatomy.
- Surgery is considered when symptoms are progressive or the spinal cord is at risk of ongoing neurological injury.
At a Glance
| Condition | Tethered cord syndrome |
|---|---|
| What it is | Abnormal attachment of the spinal cord within the spinal canal |
| Who it affects | Most often infants, children, and adolescents |
| Common signs | Back or leg pain, weakness, walking changes, scoliosis, bladder or bowel changes, or certain skin findings over the lower back |
| Diagnosis | Neurological examination and MRI |
| Treatment | Observation in selected cases or tethered cord release surgery |
| Long-term outlook | Many children do well with appropriate treatment and ongoing follow-up |
Understanding Tethered Cord Syndrome
The spinal cord normally moves freely within the spinal canal. In tethered cord syndrome, the cord is attached to surrounding tissue, restricting that movement and placing tension on the spinal cord and nerves as a child grows.
What Causes a Tethered Spinal Cord?
Tethering can occur with congenital spinal conditions such as spina bifida, lipomyelomeningocele, a thickened or fatty filum terminale, split cord malformation, or after prior surgery for a spinal defect. In some children, tethering is discovered because of symptoms; in others, a skin finding or imaging study leads to diagnosis.
Why Growth Matters
The spinal column lengthens as a child grows. If the spinal cord cannot move normally, that growth can increase tension on the cord and nerve roots. Symptoms may therefore appear or worsen during periods of rapid growth.
Signs & Symptoms
Symptoms vary with age and the degree of tension on the spinal cord. Some children develop signs in infancy, while others do not have noticeable problems until later childhood or adolescence.
What Parents May Notice
- A dimple, fatty lump, birthmark, or patch of hair over the lower back
- Foot deformities or leg weakness
- Delayed motor milestones
- Uneven leg growth
- Scoliosis or changes in spinal alignment
- Changes in bladder or bowel function
Common Symptoms
- Lower back or leg pain
- Leg weakness or numbness
- Changes in walking or balance
- Progressive foot deformity or scoliosis
- Difficulty controlling the bladder or bowels
- Frequent urinary tract infections related to bladder dysfunction
Skin Findings That May Be a Clue
A deep dimple above the buttocks, patch of coarse hair, fatty lump, birthmark, abnormal pigmentation, or small opening over the lower spine may occasionally signal an underlying spinal abnormality. Many skin findings are harmless, but certain patterns warrant pediatric neurosurgical evaluation.
When to Seek Evaluation
- New or worsening leg weakness or numbness
- New difficulty walking or loss of balance
- Loss of previously acquired motor skills
- New or worsening bladder or bowel dysfunction
- Increasing back or leg pain
- Progressive scoliosis or foot deformity
Diagnosis
Evaluation begins with a detailed history and neurological examination, including strength, sensation, reflexes, walking, spinal alignment, foot position, and bladder or bowel function when relevant.
MRI of the Spine
MRI is the primary imaging study used to evaluate tethered cord syndrome. It shows the position of the spinal cord, the filum terminale, and associated abnormalities such as lipomas, split cord malformations, or prior surgical changes.
Additional Evaluation
Depending on symptoms, your child may also need urologic testing, orthopedic evaluation, or other studies to understand how tethering is affecting neurological function.
Treatment
Treatment depends on symptoms, neurological findings, imaging, age, and the risk of future spinal cord injury.
Observation & Follow-Up
Not every child requires immediate surgery. Carefully selected children may be followed with neurological examinations and imaging while the care team watches for new or progressive symptoms.
Tethered Cord Release
During untethering surgery, the pediatric neurosurgeon carefully frees the spinal cord from tissue that restricts its movement, with the goal of relieving tension and protecting neurological function.
What Surgery Is Designed to Protect
The primary goal is often to prevent further neurological decline. Pain or weakness may improve in some children, but bladder, bowel, or longstanding neurological deficits may not fully reverse.
Long-Term Follow-Up
Children need continued follow-up as they grow because symptoms can recur and, in some cases, the spinal cord can become tethered again.
The Diagnosis-to-Treatment Pathway
1. Clinical Evaluation
Symptoms, neurological function, walking, strength, sensation, reflexes, and bladder or bowel changes are assessed.
2. MRI
Imaging is used to evaluate the spinal cord, identify tethering, and look for associated spinal abnormalities.
3. Additional Evaluation
Urologic testing or evaluation by other specialists may be recommended depending on symptoms and associated conditions.
4. Treatment Planning
The neurosurgical team determines whether monitoring or surgical treatment is appropriate based on symptoms, neurological findings, imaging, and risk of progression.
5. Tethered Cord Release
When surgery is recommended, the spinal cord is carefully released from the tissue restricting its movement, with the goal of preventing further neurological damage and improving symptoms when possible.
6. Recovery & Follow-Up
Neurological function, mobility, pain, and bladder or bowel symptoms are monitored after treatment and as the child grows.
Frequently Asked Questions
Tethered cord syndrome occurs when the spinal cord is abnormally attached within the spinal canal and cannot move freely. As a child grows, this can place tension on the spinal cord and nerves.
Tethering may occur with congenital spinal abnormalities such as spina bifida, lipomyelomeningocele, a thickened or fatty filum terminale, split cord malformation, or after prior spinal surgery.
Symptoms can include back or leg pain, weakness, numbness, walking changes, foot deformities, scoliosis, and changes in bladder or bowel function. Some children also have characteristic skin findings over the lower back.
Diagnosis is based on symptoms, neurological examination, and MRI of the spine. Additional urologic or orthopedic testing may be recommended depending on the child’s symptoms.
No. Some children can be monitored. Surgery is more likely to be considered when symptoms are progressive, neurological function is changing, or the spinal cord is judged to be at risk from ongoing tension.
The neurosurgeon carefully separates the spinal cord from tissue restricting its movement. The goal is to relieve tension and prevent further neurological injury.
Retethering can occur, particularly as a child grows. Ongoing follow-up is important so recurrent symptoms can be evaluated promptly.
Many children return to school and regular activities after recovery. Timing and restrictions depend on the child’s surgery, neurological function, and individual recovery.
Pediatric Tethered Cord Specialist at Atlantic Brain and Spine
Kate T. Carroll, MD, provides specialized pediatric neurosurgical evaluation and treatment for tethered cord syndrome and congenital spinal conditions.
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