Tethered Cord Syndrome

What is Tethered Cord Syndrome?

Tethered cord syndrome is also medically termed as occult spinal dysraphism sequence. This is a neurological disorder that is associated with the spinal cord failing to normally ascend with growth, which causes it to stretch and damage. Tissue attachments tend to limit movements of the spinal cord within the spinal column.

It is an ailment that starts early in age; at birth, but can be hard to diagnose then because it rarely shows symptoms as they are analytic and insidious. The symptoms proceed to manifest in a gradual way. Most tethered cord syndrome cases are congenital.

 

The severity of this disorder and its signs and symptoms may vary from one individual to another. At times, symptoms may appear at birth meaning congenital, and in other times, the patients may not experience any symptoms until sometimes later in their adulthood. ⁴

In tethered cord syndrome, the spinal cord tends to be stuck to a structure within the spine. This structure can be a result of a previous operation to repair damages of the tethered cord. The spinal cord may be trapped by the dura scar tissue in other cases a tumor or a bony spicule may be the cause.

Causes

This condition is brought about by several things and it is often associated with other disorders.

Spina bifida

Evaluations, test and medical studies carried out show that an estimate of 20 to 50 percent of children suffering from spina bifida or myelomeningocele tend to develop tethered cord syndrome. Spina bifida is a condition associated with abnormal development of the backbone or spine where it fails to close completely.

This , spinal cord surrounding nerves and the fluid-filled sac that surrounds the spinal cord to grow outside the body. When the spinal cord fails to separate from the skin; preventing it from ascending normally during growth so it is low-lying, the leading result is tethered cord syndrome.

Chiari malformation

This is a disease of the brain. The condition entails brain tissues being pushed down into the spinal canal. Since the hole in the skull when an individual is suffering from this ailment tends to be abnormally small, the brain is pressed downwards and is therefore forced into the spinal canal.

This leads to the person developing tethered cord syndrome. However, it only manifest after a period of time.

Other primary causes include:

• Dermal sinus tract (rare congenital deformity)
• Diastematomylelia (split spinal canal)
• Lipoma (a benign/fatty growth)
• Tumor
• Thickened and tight filum terminale (delicate filament near the tail bone)
• History of spine traumas
• History of spine surgeries.

These causes can be termed as the primary causes of tethered cord.

Symptoms

The symptoms of tethered cord syndrome are age specified. Therefore, there are three brackets that exhibit different symptoms that can be identified with tethered cord syndrome;

New born

These symptoms include;

• Unusual anatomy of the genitals. It may be accompanied by discoloration.
• Inclusively, the new born may also exhibit some unusual anatomy of the anus.
• Similarly, unusual dimple or raised bump can be termed as a symptom.

These anomalies therefore may be an early indication that the new born baby is suffering from tethered cord syndrome.

Infants and small children

Examinations of the child’s back may show neurocutaneous signs. These include:

• Dark colorations or red spots: some tufts of hairs or soft masses, all these generally appear at the child’s back.

Other indication that the child is suffering from tethered cord are; Midline skin lesions whereby there is a systemic infection that occurs all around the child’s body these lesions will eventually disappear. As time goes the child will start to experience delayed motor milestones such as late walking.

Older children and adults

Adults experience different symptoms of tethered cord syndrome as the condition tends to have gradual changes that are time based. These symptoms include:

• Back pains – since tethered cord syndrome is a spinal cord anomaly, the person in question experiences constant back pains. The spinal cord is usually outside its canal thus engaging in certain light activities by the individual leads to these extreme pains.
• Leg pains – these pains cause weakness in the lower extremities. The leg pains are hence the cause of fatigue in walking by individuals affected by this condition.
• Recurring bladder infections – tethered cord syndrome damages the urinary pattern and increases the frequency and urgency. The cause of this change leads to urinary and fecal accidents.

To some individuals, urinary frequency may also be signs of tethered cord syndrome without necessarily having to experience back pain or lower extremities.

Diagnosis

Tethered cord syndrome diagnosis basically is based on neurological and musculoskeletal signs and symptoms. Clinical evaluations like rectal exam and bladder dysfunctions are the forms of diagnosis carried out. Thus, the use of imaging features that follow are for support in regards to the diagnosis. The imaging supports that can be carried out therefore are:

Magnetic resonance imaging:

MRI are used to produce three dimension images of the body structure. They can show enlargement degeneration and displacements that occur in the spinal cord due to this disorder.

Myelogram

This includes the use of x ray. There is the use of injections of a contrast material into the thecal sac to show pressure on the spinal cord and nerves.

Other imaging supports used in the diagnosis include:

• Use of computed tomography scans (CT Scans) can also aid in identifying the impact and position of the ailment.
• Use of ultra sounds to check the spinal cord moving in the thecal sac.

Thus, with all these support methods correct diagnosis of tethered cord syndrome can be correctly done and treatment can commence.

Treatments

Tethered cord syndrome is treated based on the underlying causes; if the only abnormality is a thickened shortened filum, then a limited lumbo-sacral laminectomy with division of the filum may be enough to relieve the patient.

Physical therapy

This is whereby there is use of physicals therapeutic exercises. However, this form of treatment can only be used on individuals who are old enough and reliable to relay if the treatment is improving their conditions or worsening.

Surgery (Laminectomy)

The removal of part or all of the vertebral bone (lamina). This form of treatment can be used when all other forms of treatments have failed. Surgery tends to have complications like infections, bleeding and leak of fluid from the sac thus constant surgery is required.

Consequences of Untreated

Untreated tethered cord can have fatal implications on individuals if they fail to get treated. Collapse in motor and sensory function may occur. This is so since tethered cord syndrome affects the spinal cord. The individual can also lose their bladder functions. With these, the neurological and motor impairments are irreversible.

Reference List

1. Adult Tethered Cord. www.spinecenter.ucla.edu/adult-tethered-cord
2. Tethered Cord Syndrome. https://rarediseases.info.nih.gov/diseases/4018/tethered-cord-syndrome
3. Tethered spinal cord syndrome. https://en.wikipedia.org/wiki/Tethered_spinal_cord_syndrome
4. Tethered Cord. https://www.beaumont.org/conditions/tethered-cord
5. Tethered Cord Syndrome. https://rarediseases.org/rare-diseases/tethered-cord-syndrome/
6. Tethered Cord Syndrome. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Tethered%20Spinal%20Cord%20Syndrome.aspx