What is anatomy of tethered cord syndrome ?

The spinal cord typically floats freely within a tube-like structure called the spinal canal. However, in cases of a tethered spinal cord, it is pulled down and firmly attached to the inside of the spinal canal. As a child grows, a tethered spinal cord can stretch like a rubber band. In         tethered cord syndrome (TCS), attachments such as a thickened filum terminale, lipomas, or scar tissue can limit this movement. This restriction becomes more significant as the body grows or when the spine moves, leading to abnormal stretching, compromised blood flow, and potential damage to the spinal nerves.

                 If left untreated, this condition can cause lasting damage to a child’s spinal nerves, potentially resulting in loss of function, such as the ability to walk or control bladder function.

What are conditions leading to tethered cord syndrome ?

Tethered spinal cord is most commonly found in children who are born with conditions affecting the spinal cord. These conditions include:

1. Myelomeningocele: This is the most severe form of spina bifida, where a small sac protrudes through an opening in the spine.
2. Lipomyelomeningocele: In this condition, a fatty mass is attached to the spinal cord.
3. Fatty filum: This occurs when the very end of the spinal cord is anchored too tightly. The flexible fibre that connects the spinal cord to the lower spine bones is thicker than usual. Other causes of tethered cord syndrome include

• Dermal sinus tract (a rare congenital deformity)
• Diastematomyelia (split spinal cord)
• Lipoma (a benign, fatty growth)
• Spinal Tumor
• A history of spine surgery

What are the  symptoms ?

• Skin markers – Hairy patch, dimple, fatty lump over lower back and skin discolouration in lower back or pigmented patches anywhere in the body
• Neurological disturbance – Leg weakness, numbness, abnormal gait,
• Deformity – Scoliosis, toe walking, limb asymmetry, Deterioration in gait , foot deformities
• Urological symptoms – Urinary incontinence or retention, bowel dysfunction
• Sensory disturbances in foot and legs leading non healing wounds
• Back and leg pain , especially during growth spurts

Symptoms may worsen as the  child grows, due to increased tension on the spinal cord

How tethered cord syndrome is diagnosed ?

• Diagnosing tethered cord syndrome requires a combination of clinical evaluation and imaging, with MRI being the most crucial and dependable diagnostic tool

Multidisciplinary team consisting of  neurosurgeons , paediatricians , urologist and orthopaedicians in clinical evaluation and treatment planning.

What is the surgical treatment for tethered cord syndrome

Detethering surgery involves a laminectomy, which is the removal of a portion of the vertebral bone, to access the spinal canal and cord . The surgeon then carefully releases the abnormal attachments, freeing the spinal cord from the surrounding tissues

What are indications or when is surgery needed in tethered cord syndrome?

• Children with signs and symptoms
• Adult with tethered cord syndrome
• Asymptomatic individuals may also be considered for detethering to prevent future neurological issues, especially in children

There is no role of conservative treatment

What can parent expect post-surgery ?

In most of the cases  , they are discharged in 4 to 5 days , and follow up after 2 weeks for wound inspection.

On long term follow up , symptom monitoring for signs of retethering , Urological follow-up if bladder dysfunction persists before surgery , spinal imaging  if needed and orthopaedic evaluation for scoliosis , gait abnormalities and foot abnormalities and rehabilitation