Tethered Cord Syndrome
An abnormally anchored, stretched spinal cord
Quick Facts
- Type: Spinal cord disorder
- What happens: Spinal cord is abnormally anchored and stretched
- Often linked to: Spina bifida and spinal abnormalities
- Main treatment: Surgery to release the cord
Overview
Tethered cord syndrome is a condition in which the spinal cord is abnormally attached (tethered) to surrounding tissue within the spinal column. Normally the spinal cord hangs freely and can move slightly as the body grows and bends. When it is tethered, it cannot move normally and becomes stretched, which over time can reduce blood flow and impair the nerves it contains.
The condition is often present from birth and is frequently associated with spina bifida and other spinal abnormalities, although it can sometimes develop later from scarring, injury, or a tumor. Symptoms may appear in childhood as a child grows, or in some cases not until adulthood. Because progressive stretching can cause lasting nerve damage, recognizing the condition and treating it, usually with surgery to release the cord, is important for protecting function.
Symptoms
Symptoms vary with age and can develop gradually as the spinal cord is stretched. They may include:
- Lower back pain, which is common in adults and may worsen with activity
- Leg pain, weakness, or numbness
- Changes in walking, balance problems, or difficulty with coordination
- Bladder and bowel problems, such as incontinence or difficulty emptying
- Foot and spine changes, such as foot deformities or a curvature of the spine (scoliosis)
- Skin changes over the lower back, such as a dimple, patch of hair, or birthmark, which can be a clue in infants
In children, worsening of these problems as they grow, or new bladder difficulties, may be the first signs. In adults, symptoms can be triggered or worsened by activities that stretch the spine.
Causes
Tethered cord syndrome occurs when something anchors the spinal cord abnormally. Causes include:
- Spina bifida and birth abnormalities: The most common association, where the spinal cord is tethered as part of a neural tube defect.
- A thickened or fatty filum terminale: The strand of tissue at the lower end of the cord may be tight and restrict movement.
- Fatty masses (lipomas): Fat deposits attached to the cord.
- Scar tissue: From previous spinal surgery or injury.
- Tumors or other lesions: Less commonly, growths can tether the cord.
Risk Factors
- Spina bifida or other neural tube defects
- Previous spinal surgery
- Spinal injury
- Certain skin findings over the lower spine present from birth
- A family history of spinal abnormalities
Diagnosis
Diagnosis combines a neurological evaluation with imaging:
- MRI: The main test, showing the position of the spinal cord and any tethering, fatty masses, or other abnormalities.
- Neurological examination: Testing strength, sensation, reflexes, and coordination.
- Bladder testing (urodynamics): To assess bladder function, which is often affected.
- Ultrasound: May be used in young infants whose spine has not fully hardened.
Because symptoms can overlap with other conditions, careful evaluation by specialists helps confirm the diagnosis and plan treatment.
Treatment
The main treatment is surgery to release the spinal cord, with the goal of preventing further nerve damage:
- Surgical release (untethering): A neurosurgeon frees the spinal cord from the tissue anchoring it, relieving the stretch.
- Timing: Surgery is often recommended when symptoms are present or progressing, to protect function; decisions are individualized.
- Supportive care: Physical therapy, bladder management, and treatment of related problems such as scoliosis.
- Follow-up: Ongoing monitoring, since tethering can sometimes recur, especially in growing children.
Surgery often halts the progression of symptoms and can improve some of them, though results depend on how much nerve damage occurred before treatment.
Prevention
Tethered cord syndrome itself usually cannot be prevented, but related steps can help:
- Taking folic acid before and during early pregnancy reduces the risk of neural tube defects, which are commonly linked to tethered cord
- Attending recommended prenatal care
- Reporting back or lower-spine skin markings present from birth so a doctor can evaluate them
- Seeking early evaluation of new neurological, bladder, or walking problems to allow timely treatment
When to See a Doctor
See a doctor if you or your child develop progressive leg weakness, numbness, back or leg pain, changes in walking, or new bladder or bowel problems, especially with a history of spina bifida or spinal surgery. Seek prompt medical care for:
- New or rapidly worsening leg weakness or numbness
- Sudden loss of bladder or bowel control
- Numbness in the groin or inner thighs
These can signal significant spinal cord or nerve involvement that needs urgent evaluation. Unusual skin markings over a baby's lower spine should also be checked by a doctor.
Frequently Asked Questions
What is tethered cord syndrome?
It is a condition in which the spinal cord is abnormally attached within the spine and cannot move freely, so it becomes stretched. Over time this can impair the nerves and cause leg weakness, numbness, back pain, and bladder problems. It is often linked to spina bifida.
What are the symptoms of a tethered spinal cord?
Symptoms include lower back and leg pain, leg weakness or numbness, changes in walking or balance, bladder and bowel problems, and sometimes foot deformities or scoliosis. In infants, an unusual dimple, hair patch, or birthmark over the lower back can be a clue. Symptoms may worsen with growth.
How is tethered cord syndrome treated?
The main treatment is surgery to release the spinal cord from the tissue anchoring it, which relieves the stretch and helps prevent further nerve damage. Supportive care includes physical therapy and bladder management. Surgery often halts progression and may improve some symptoms, depending on prior damage.
Can tethered cord syndrome appear in adulthood?
Yes. Although often present from birth, symptoms may not appear until adulthood, sometimes triggered by activities that stretch the spine, or it can develop later from scarring or injury. Adults often present with lower back pain, leg symptoms, or new bladder problems.
When should I seek urgent care for tethered cord symptoms?
Seek prompt medical care for new or rapidly worsening leg weakness or numbness, sudden loss of bladder or bowel control, or numbness in the groin or inner thighs. These can indicate significant nerve involvement requiring urgent evaluation, particularly in someone with a known spinal condition.
References
- National Institute of Neurological Disorders and Stroke (NINDS). Tethered spinal cord syndrome.
- American Association of Neurological Surgeons (AANS).
- MedlinePlus, U.S. National Library of Medicine.
- Genetic and Rare Diseases Information Center (GARD).