Tethered cord syndrome (TCS) can be either a congenital defect that occurs with or without spina bifida or a side effect of any spinal column surgery. Tethered cord syndrome occurs when the spinal cord fastens itself to the spinal column, most often in the lower back, and can cause both physical and developmental symptoms. TCS is most often treated with surgery to detach the cord from the column.
The spinal cord is meant to hang freely within the spinal column. TCS makes the cord unable to do this; the condition forces the spinal cord to stretch as the body grows or moves, thereby affecting the nerves and neurological development and function. Spina bifida, which occurs in the first trimester of pregnancy when the neural tubes fail to close, can cause the cord to fasten to the column, limiting growth of the cord. In some cases, TCS can be present at birth without spina bifida, although this is rare. Tethered cord syndrome can also happen following the surgery for spina bifida or other spinal surgeries. The cord can essentially catch on scar tissue left behind by surgery, thus causing TCS.
Symptoms of TCS can include skin discoloration or lesions and the presence of fat deposits on the back. It can, in some cases, also cause excess hair to grown on the back. Tethered cord syndrome can cause developmental delays in children, foot deformities, and back pain. In adults, it can cause issues with walking and a loss of control over the bladder and bowels. Symptoms vary based on where on the spinal column the cord is attached.
Tethered cord syndrome is typically diagnosed with an X-ray and MRI. A relatively short surgery, usually five hours, is then performed to detach the cord from the column. In cases of congenital tethered cord syndrome, if surgery takes place early enough, symptoms can be eliminated or drastically reduced. In adults, if done promptly, the surgery can also reverse most of the damage. Both newborns and adults who suffer from tethered cord syndrome are likely, however, to always have issues with bladder and bowel control, although the severity may lessen after surgery. In many cases, neurological issues due to TCS are not reversible, although early surgery can greatly limit the amount of neurological damage.
Both children and adults who have tethered cord syndrome may require several follow-ups to determine whether the cord has reattached itself to the column, which is a relatively common problem. Just as the cord can catch on scar tissue from previous surgeries, it can get caught on the scar tissue left behind by the surgery to treat TCS. Therefore, subsequent surgeries are common.