Tethered cord syndrome (TCS) is a disorder in which spinal cord is attached to the spinal canal during its developmental period. Normally spinal cord is not attached to the spinal canal and is freely mobile in the spinal canal. It can move up and down freely with the growth of the baby and during stretching or twisting the spine. In tethered cord syndrome, spinal cord is attached to the lower end of the spinal canal and stretch is applied on the spinal cord when the spine is bent causing tearing of the spinal cord and any spinal nerves emerging from the spinal cord. It is associated with all types of spina bifida. The signs and symptoms of the TCS are much similar to spina bifida occult. Most often, signs and symptoms do not appeared and are minimal. Signs and symptoms are age related so they are different depending on the age groups. Surgery is the only option for symptomatic TCS and it is mainly centered on the stabilization of the neurological functions of the affected body parts.
Symptoms in Babies
The symptoms in babies suffering from this condition are related to their developmental milestones. For example, their motor reflexes are delayed. The baby is not active and cannot attain the motor milestone at the usual age. Some signs are also visible on the baby with TCS. These signs are mentioned below :
- Abnormal growth of hair on the back of the baby at lower end of the spine
- Abnormal swelling or mass of fatty tissue on the back of baby
- A swelling with bluish discoloration on the back of baby in midline. This type of swelling is most common in the head region, but is not dangerous.
- A small sinus tract on the lower back of the baby in midline
Symptoms in Adults
The tethered spinal cord in adult is most often encountered due to the presence of some abnormal tissue in the spinal cord. Therefore, spinal cord is stuck to the tissue and cannot move freely. Some of the common symptoms are given below :
- Severe back pain radiating to the lower limbs and groin area
- Abnormal length of the affected limb with the length of the other unaffected limb
- Abnormal gait of the patient
- Sensory loss of lower limbs
- Numbness and muscle weakness of both limbs
- Urinary tract system related problems
- Neurological symptoms
- Bowl control problems
- Abnormal curvature and twisting of the spine (scoliosis)
Muscular pain in the back is the most common and striking symptom of the tethered cord syndrome. It radiates to the area where spinal nerves are affected, stretched or compressed. Most affected areas include lower back, groin, premium and lower limbs. Pain can be caused by several other reasons; therefore, all possible causes must be ruled out to offer proper treatment.
Abnormal Leg Length Ratio
The length of the affected limb is decreased as compared to the normal unaffected limb due to the loss of nerve supply to the muscles of the affected limb. Muscles become paralyzed and shorter in length and the leg length ratio is altered.
Gait of a person tells many things. Abnormal gait may be associated with TCS as the effected nerve supply to the muscles of leg causes them not to work properly.
Sensory Loss of Lower Limbs
Sensations over the lower limbs are affected in TCS because spinal nerves are damaged due to stretching of the spinal cord and halted nerve supply.
Numbness and Muscle Weakness of Lower Limbs
Numbness and muscle weakness of lower limbs are common complains of a person with TCS. The reason behind this complaint is the compression of spinal nerves due to the presence of abnormal fatty tissue around the spinal cord. This abnormal tissue halts the proper nerve supply to the muscles of the lower limbs causing muscle weakness and numbness, and hence reduced or defective performance.
Neurological symptoms are a mixture of findings; the neurons which come from the brain to the spine and the neurons which reach to the organs from the spine can be affected. In TCS, reflexes are exaggerated, muscles are flaccid and planter responses are also abnormal.
Urinary Tract System Related Symptoms
The urinary tract system is commonly affected by TCS. Usually, the patient presents with urinary incontinence or retention. According to medical sciences, the nerve supply of urinary bladder comes from the lower sacral segments of the spinal cord. In TCS, spinal nerves of this region are affected and their supply is disturbed. Common complaints associated with urinary tract system are given below:
- Continuous dribbling of urine
- Frequency (multiple times urge to pass urine in a day)
- Urgency (decreased control over the bladder to store urine)
- Nocturia (urge of urine during sleeping hours)
- Bedwetting even after completing training to go to the toilet
All the above symptoms may also be associated with other spinal cord disorders. So, tethered cord syndrome should be diagnosed properly.
Bowel Control Problems
Bowel movements are often found to be disturbed by TCS. Sometimes, bowel movements are decreased causing constipation and sometimes bowel movements are so exaggerated to cause fecal incontinence. Again these problems happen to occur due to damage to the spinal nerves contained in the spinal canal of the patients with TCS.
It is vital to diagnose the tethered cord syndrome in a proper and precise way as most of the symptoms of this syndrome are shared by spina bifida occulta.
For the reason of explanation, most of the symptoms of TCS are not found in all the patients. However, as the severity increases, the number of symptoms increases.
Figure 1: This is a picture of MRI scan of spinal cord in which tethered cord is shown. A mass is compressing the spinal cord causing tethered cord syndrome (blue arrow). A red circle is made around the specified area of spinal cord where tethered cord is present. (Source: www.guide.ispneurosurgery.org)
Figure 2: This is a picture of a sign of tethered cord syndrome. A small sinus tract is present on the lower back of the baby in the midline. This sinus has communication with the spinal canal. The red circle is made around the sinus in this picture. (Source: www. ispn.guide.com)
1. Hertzler DA, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2010 Jul; 29(1):E1.
2. Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. Pediatr Neurosurg 2007; 43(3):236-48.