Tethered Cord Syndrome can be difficult to diagnose in babies and children since the symptoms may be subtle and insidious over time. The most common symptoms of tethered cord, such as back pain, abnormal gait and urinary accidents are frequently attributed to other causes during childhood. “Tethered spinal cord is frequently misdiagnosed, or identified after symptoms have been long-standing, but proper treatment can lead to a full recovery,” says Holly Gilmer, M.D., Chief of Pediatric Neurosurgery at Beaumont Hospital Royal Oak.
Tethered Cord (TC) is a disorder in which the spinal cord is “stuck” to a structure within the spine such as dura, scar tissue from a previous operation, a bony spicule or even a tumor. Although most cases are congenital, the condition may not become symptomatic until later in life as the cord continues to grow and lengthen. TC most often occurs in patients with spina bifida, although it is frequently seen with Chiari malformation. TC can affect people of all ages, but it is most often found in people ranging from infancy to teen. Symptoms of tethered cord become more pronounced during periods of rapid growth due to increased stretching of the spinal cord.
Symptoms of tethered cord are age-specific. Older children and adults may experience back pain, leg pain, weakness in the lower extremities and/or fatigue with walking. Recurrent bladder infections, urinary or fecal accidents, as well as urinary frequency, hesitancy and urgency may also be signs of TC with or without back and lower extremity symptoms.
Babies may experience delayed motor milestones such as late walking. Examination of the back may also show neurocutaneous signs, such as dark or red spots, tufts of hair or soft masses. Those skin lesions associated with TC tend to be midline. Severe cases of tethered cord may show symptoms like scoliosis or other curvatures of the spine. Leg-length discrepancies, differences in the size of the legs/feet, and foot deformities are also seen in severe cases.
A spinal MRI is obtained to confirm the diagnosis of tethered cord.
If the patient has predominantly back pain and mild weakness, a course of physical therapy may provide tethered cord treatment. This approach requires the patient to be old enough to reliably convey whether the symptoms are worsening or improving. In most cases, surgical treatment of tethered cord is needed to prevent neurologic deterioration. A laminectomy is performed, the dura is opened and using the operating microscope, the spinal cord is freed from the tethering structure. If possible, the tethering object is removed. “If the object stuck to the cord is a bony spicule or tumor, it is removed in an attempt to avoid re-tethering, which can often happen,” says Dr. Gilmer.
Recovery from the surgery is one to two weeks of very limited activity to ensure proper healing of the surgical site and to prevent leaking of any cerebrospinal fluid. However, most patients are not required to undergo physical therapy post-operatively. Many patients regain normal function and are pain-free following surgery.
Patients with untreated tethered cord will continue to experience their current symptoms, and their motor and sensory function may worsen. Particularly in children, lengthening of the spine with growth can lead to paraplegia and loss of bowel and bladder function. "Chronic back and leg pain in children is not common and should not be taken lightly. Children with symptoms of tethered cord should undergo radiologic imaging and evaluation by a specialist without delay," says Dr. Gilmer.
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