TETHERED CORD SYNDROME
Tethered cord syndrome is a neurological disorder caused by a tissue attachment that limits the movement of the spinal cord within the spinal column. This tethering causes the spinal cord to be stretched and damaged as the body grows and moves.
SYMPTOMS
- Back Pain: Often in the lower back, increasing with activity.
- Leg Weakness or Numbness: Affects walking and coordination.
- Foot Abnormalities: Such as high arches or curled toes.
- Bladder and Bowel Problems: Incontinence or difficulty with urination and bowel movements.
- Scoliosis: Abnormal curvature of the spine, which can be associated with tethered cord.
- Skin Abnormalities: Such as a fatty lump, dimple, or patch of hair on the lower back.
- Muscle contractions: such as clonus
CAUSES
Congenital (present at birth):
- Spina Bifida: A birth defect where the spine and spinal cord don't form properly, often associated with tethered cord.
- Lipoma: Fatty tissue that can attach to the spinal cord.
- Thickened Filum Terminale: The end part of the spinal cord may be thicker than normal and cause tethering.
- Diastematomyelia: A condition where the spinal cord is split into two parts, often causing tethering.
Acquired:
- Surgery: Scar tissue from previous spinal surgeries can cause tethering.
- Injury: Trauma to the spine can result in scar tissue that leads to tethering.
DIAGNOSIS
- Clinical Examination: Doctors look for physical signs and symptoms.
- Imaging Studies: MRI is the most common imaging test used to diagnose tethered cord syndrome, providing detailed images of the spinal cord and surrounding tissues.
- Urodynamic Tests: To assess bladder function if urinary symptoms are present.
TREATMENT
Conservative Management:
- Monitoring and physical therapy: for mild cases without severe symptoms.
Surgical Intervention:
- Detethering Surgery: The primary treatment, which involves surgically releasing the spinal cord from the attached tissue. This aims to restore the normal movement of the spinal cord and prevent further damage.
- Postoperative Care: Includes physical therapy and regular follow-up to monitor recovery and ensure that the spinal cord remains free.
POTENTIAL COMPLICATIONS
- Neurological Damage: If untreated, the ongoing tension can cause permanent damage to the spinal cord.
- Re-tethering: In some cases, the spinal cord may tether again after surgery, requiring further intervention.
- Infection and Bleeding: Risks associated with any surgical procedure.
PROGNOSIS
Early diagnosis and treatment are crucial for preventing long-term complications. Many patients experience significant relief of symptoms and improved quality of life after surgery. Regular follow-up is important to monitor for potential recurrence of tethering and manage any ongoing symptoms.
OCCULT TETHERED CORD
Occult tethered cord syndrome (OTCS) is a condition where the spinal cord is abnormally stretched or anchored, but without the obvious, visible signs seen in classic tethered cord syndrome. The term "occult" means hidden, indicating that the tethering is not easily detected through standard imaging tests or physical examination. OTCS seems to be more prevalent in patients with CCI or ehlers-danlos syndrome, however more research is needed.
CAUSES
- Congenital Abnormalities: Even though the condition is hidden, it may still be caused by subtle congenital anomalies.
- Trauma or Surgery: Scar tissue from previous spinal surgeries or injuries can cause occult tethering.
- Degenerative Changes: Age-related changes in the spine that may not be immediately apparent.
SYMPTOMS
The symptoms of OTCS are similar to those of classic tethered cord syndrome but may be more subtle and harder to diagnose.
DIAGNOSIS
It is often a clinical diagnosis based on symptoms and physical findings, however in some cases prone lumbar MRI scans are used to identify signs of an occult tether. This is still a fairly new concept and not widely used.
SOURCES
Tethered Spinal Cord Syndrome – Causes, Diagnosis and Treatments
Tethered Spinal Cord Syndrome | National Institute of Neurological Disorders and Stroke
Tethered Cord Syndrome - Symptoms, Causes, Treatment | NORD
Tethered cord syndrome | Radiology Reference Article | Radiopaedia.org
Occult tethered cord syndrome: a rare, treatable condition
https://thejns.org/spine/view/journals/j-neurosurg-spine/40/6/article-p758.xml?tab_body=fulltext
Full article: Effect of untethering on occult tethered cord syndrome: a systematic review