Tethered Spinal Cord Syndrome is a neurological disorder
casued by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments
cause an abnormal stretching of the spinal cord and can cause neurological damage as the tightness increases due to continued
growth of the spinal column.
What are the symptoms?
-Decrease in strength of legs or feet
-Pain
in the lower back region
-Loss of reflexes and sensation in the legs
-Scoliosis (curvature of the spine)
-Skin
abnormalities directly overlying the spinal cord, such as a hairy patch, dimple or birthmark
-Spasticity
-Changes
in gait
-Elimination pattern changes (bladder or bowel)
-Frequent urinary tract infections
-Imperforate anus
Common Causes of a Tethered Spinal Cord
Lipoma or Lipomyelomeningocele
Tethering is due to fatty tissue connecting to the lower end of the spinal cord. This fatty tissue attaches
to surrounding tissues of the back.
Split Cord Malformation
(Diastematomyelia)
A congenital condition where the spinal cord is split into two halves. The split
can occur at any level and the split cords may reconnect or not at some point below the split. The bone, cartilage or
fibrous tissue between the two halfes of the spinal cord causes the tethering.
Dermal
Sinus Tract
A small dimple-like opening in the middle of the spine that may connect
deep into the spinal cord. These are usually located in the lower back. the tethering is caused by the dermal
sinus being attached to the end of the spinal cord.
Fatty Filum Terminale
A small, threadlike piece of tissue that connects the lower end of the spinal cord to the end of the
spinal canal. This is called the filum terminale. If the filum is shorter than normal, it pulls the spinal cord
down and causes tethering
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Diagnosis
-Magnetic resonance
imaging (MRI)
A diagnositc test that produces three-dimensional images of body
structures; it can show the spinal cord, nerve roots and surrounding areas.
-Manual
muscle test (MMT)
Performed by a physical therapist to assess strength, or lack
thereof, of lower extremeties.
-Urodynamics studies
CMG
testing, which evaluates bladder capacity, emptying and pressure. Voiding cysto-urethrogram which evaluates reflux.
Usual Treatment for Tethered Spinal Cord
Upon
presentation of symptoms, non surgical treatment is not usually effective. Early symptoms will progress and worsen as
time passes without surgical untethering. Two things are hoped to be accomplished by untethering. One, to stop
further neurological deterioration. Two, to hopefully see some improvement in any lost function, however, some neurological
function may never be recovered.
The ultimate goal of the TSCSA is to minimize symptoms of individuals affected
by TSCS and dedicate research to finding causes, cures, and efficient treatment of chronic tethers.
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