Tethered Spinal Cord

A condition where the lower end of the spinal cord is abnormally attached to tissue, becoming taut and causing nerve strain as the child grows.

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Pediatric Neurosurgery

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1Overview

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What is this Condition?

Tethered spinal cord syndrome is a condition where the lower end of the spinal cord is anchored abnormally lower than it should be, attached to abnormal tissue (thickened ligament, fatty tissue, cyst, or scar tissue). Normally, the lower end of the spinal cord terminates freely; however, in tethered spinal cord, because it is fixed in place, tension increases particularly during growth periods when spinal bones lengthen, potentially causing nerve damage. It occurs in two forms: congenital type (usually associated with developmental variations in the lumbar region, often symptomatic in childhood) and acquired type (following previous spinal surgery or post-traumatic scar tissue, occurring at any age). Symptoms develop insidiously: leg/back pain, weakness, gait disturbance, urinary-bowel problems, foot deformities, and skin findings in the lower back area (hirsutism, dimples, birthmarks, lipomas). Early diagnosis and surgical detethering can halt progression.

Symptoms

Back and leg pain (worsening with activity, exercise, or prolonged standing)

Gradually progressive weakness and muscle atrophy in the legs

Gait disturbance (limping, toe walking)

Foot deformities (inverted feet, high arches, foot drop)

Urinary problems (incontinence, frequent urination, urinary tract infections) and constipation

Skin findings on the lower back (hirsutism, dimples, birthmarks, or lipomas); spinal curvature

Diagnosis Methods

Spinal MRI is the primary diagnostic method (gold standard); it shows whether the lower end of the spinal cord is positioned abnormally low, the thickened ligament or fatty tissue attached to it, and any associated developmental variations. Evoked potential tests (SSEP, MEP) and EMG can be used to assess nerve and muscle function. Urodynamic studies are performed to measure bladder function, and plain radiographs are taken to assess spinal curvature. Additionally, detailed neurological, urological, and orthopedic examinations complete the diagnosis.

Treatment Methods

The cornerstone of treatment is surgery to free the spinal cord from the structures causing tension (detethering operation). During surgery, the spinal canal is opened, and under the microscope, the structure causing tension (thickened ligament, fatty tissue, scar tissue) is carefully cut or removed while protecting the spinal cord and nerve roots through intraoperative neurofiziological monitoring (SSEP, MEP, EMG) throughout the procedure. The goal is to halt progression and preserve existing function; pain and urinary symptoms may improve in most patients, while partial recovery may be seen in weakness. In asymptomatic cases detected incidentally, observation may be preferred. Post-operative physical therapy, urology, and orthopedic follow-up are part of the management. In some patients, retethering may develop over time, requiring re-operation.

Microsurgical detethering of the spinal cord (detethering operation)

Cutting/removal of structures causing tension (thickened ligament, fatty tissue, or scar tissue)

Intraoperative neurofiziological monitoring to protect nerves (SSEP/MEP/EMG)

Post-operative physical therapy, urology, and orthopedic follow-up

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Craniosynostosis Surgeries

Craniosynostosis Surgeries procedure

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Fronto-Orbital Advancement

Fronto-Orbital Advancement procedure

Open treatment detail

Calvarial Reshaping

Calvarial Reshaping procedure

Open treatment detail

Oksipitoservikal posterior dekompresyon + duraplasti

Oksipitoservikal posterior dekompresyon + duraplasti procedure

Open treatment detail

References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Di Rocco C, Pang D, Rutka JT, eds. Textbook of Pediatric Neurosurgery. Springer; 2020.
Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
Principles and Practice of Pediatric Neurosurgery.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Tethered Spinal Cord

Pediatric Neurosurgery

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Craniosynostosis Surgeries

Fronto-Orbital Advancement

Calvarial Reshaping

Oksipitoservikal posterior dekompresyon + duraplasti

References

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Oksipitoservikal posterior dekompresyon + duraplasti

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