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> Tethered Spinal Cord
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Tethered Spinal Cords

Tethered spinal cords are a group of complicated developmental malformations of the spinal cord. These are benign conditions that can cause terrible consequences if not treated. There is some overlapping of the naming of these conditions and some of them are cases of closed Spina Bifida.

The various forms include such conditions as: tight filum terminale, lipomeningomyelocele, split cord malformations, dermal sinus tracts, dermoids and cystoceles.

In general, what all of these conditions have in common is a pulling on the spinal cord at the base of the spinal canal. As children grow, their spinal cords do not grow as quickly as their spinal columns so, relatively, the spinal cord must be able to freely ascend on the inside of the spinal column during growth. If various abnormal structures are holding onto the spinal cord from below, it stretches the spinal cord and this can lead to progressive loss of function.

What are the symptoms of Tethered Spinal Cords?

Signs and symptoms of tethered cords in children vary considerably. Initially children may complain of generalized back or leg pain and as they grow where more tension is placed on the tethered area, bowel and bladder problems or trouble with walking or balance may present. In some cases, tethered cords may be suspected by the pediatrician when there has been a regression in bladder or bowel continence and other skin signs are present such as a mass of coarse, dark hair or a birthmark over the lower spine area. Other signs may be a deep, sacral, skin tags or growths, or a deviated buttock crack.

How are Tethered Spinal Cords diagnosed?

Often these obvious skin signs will lead to imaging such as an ultrasound of the sacral region. An ultrasound is most often the first test performed as the infant does not need to be sedated with anesthetic for the procedure. If the ultrasound results are not conclusive, a MRI of the spine where the infant/child is sedated is usually required to confirm the diagnosis and show the extent of the tethering.

Example of a Lipomyelomeningocele on MRI.

Treatment of Tethered Spinal Cords

Many pediatric neurosurgeons recommend that these conditions should be operated on, especially if children are symptomatic. The operation is tailored to the specific cause of the tethering. Typically, neurosurgeons will have neurophysiologists monitor spinal cord and nerve function during the delicate operation to minimize risk to these structures.