Tethered spinal cord syndrome is a condition closely linked to spina bifida but which can also occur as a result of injury to the spinal cord in childhood or adult life. This neurological disorder is caused by abnormal tissue attachments in the spine that restrict movement of the spinal cord and create problematic tension in the spinal cord. It may be a result of congenital issues or can arise from spinal stenosis or be exacerbated by pregnancy, or as a result of sporting activities. Surgery for a tethered spinal cord may be necessary in some cases, in others a mix of medications and physical therapy may suffice to relieve symptoms.
A Cause of Back Pain in Children
In children, a tethered spinal cord is closely connected to spina bifida as it appears to be a result of neural tube growth defects during the development of the foetus. Symptoms may not arise until adulthood, however, when the spine is more fully developed. Tissue attachments occur in the conus medullaris (at the base of the spine) and cause a stretching of the spinal cord. The condition gets progressively worse as the attachment develops and further restricts the spinal cord’s movement. Childhood symptoms of spinal cord tethering include:
- Fatty tumors in the lower back
- Hairy patches on the lower back
- Dimples in the spine
- Leg weakness
- Low back pain
- Foot and spine deformities
Tethered Spinal Cord Symptoms in Adults
In adults, a tethered spinal cord may occur in any region of the spine following injury. Changes in ligament laxity during pregnancy can also lead to acute symptoms of a tethered spinal cord, as can spinal stenosis from osteoarthritis. Particularly sporting activities that place excess strain on the spine may also exacerbate an underlying condition, with bodybuilders, gymnasts, and also those working in highly physical construction jobs thought to be at particular risk of this condition. Symptoms of a tethered spinal cord in adulthood include many of those found in children with the congenital condition but also:
- Sensory problems
- Issues with motor control
- Bowel and bladder incontinence
- More severe pain
Treatments for Tethered Spinal Cord Syndrome
It is not always necessary to undergo surgery for a tethered spinal cord, with some adult patients able to experience relief through the use of analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), opiates, and natural pain-killers. Anti-depressants may also have a role to play in managing symptoms of this condition as they can help relieve severe pain and discomfort, as well as help with anxiety and depression that may arise as a result of impaired mobility, chronic pain, and the risk of surgery. Muscle relaxants and physiotherapy can also help relieve symptoms and improve mobility and some patients may be prescribed antibiotics or other drugs to reduce the incidence of urinary tract infections connected to impaired bladder control.
Spinal Stenosis Surgery for Tethered Spinal Cord Syndrome
Treating a tethered spinal cord often involves surgery for childhood cases, usually soon after diagnosis as this can reduce the risk of permanent and severe nerve damage. Children, and adults, who undergo tethered spinal cord surgery may experience a recurrence of symptoms, especially when children go through rapid growth spurts or when spinal trauma or pregnancy affect the structures in the spine.
Surgery to Sever Spinal Nerves
In some cases it may be that spinal nerves need to be severed in order to relieve pain. The risks and benefits of this kind of surgery for spinal stenosis and a tethered spinal cord clearly need careful consideration. Dethering the spinal cord can help lessen the risk of cyst development in the spinal cord, as well as reducing the likely size of any cysts that do arise. Many patients experience improvements in motor and sensory function when the spinal cord is freed by surgery.
Early Intervention to Detether the Spinal Cord
The best chance of a successful recovery from surgery and a reduction in symptoms of a tethered spinal cord requires prompt treatment so as to preserve neurological function and give the spine the best chance at healing any initial damage. As symptoms of a tethered spinal cord can look and feel similar to those of spinal stenosis from existing osteoarthritis it can be difficult to spot the condition early in such cases. It is important, therefore, that patients discuss any new symptoms or worsening of existing symptoms with their physicians as soon as possible so as to rule out a tethered spinal cord and spinal stenosis as a cause of low back pain, muscle weakness and loss of motor control, or more intense back pain.