Tethered Spinal Cord

What is a tethered spinal cord?

A tethered spinal cord happens when your spinal cord abnormally attaches to the wall of your spinal canal. Usually, your spinal cord moves freely inside your spinal canal.

When your spinal cord attaches to your spinal canal, this can limit its movement and cause tension. This tension can cause your spinal cord to stretch and may damage it and restrict blood flow to your spinal nerves.

Other names for a tethered spinal cord include:

• Tethered cord syndrome.
• Tethered spinal cord syndrome.

What is the spinal cord?

Your spinal cord is the thick column of tissue running from your skull base to the center of your back. Nerve signals running through your spinal cord help you move and feel sensations.

What is the difference between a tethered spinal cord and spina bifida?

Children with spina bifida may have a tethered spinal cord when they’re born. In the more severe forms of spina bifida, such as myelomeningocele, the lower tip of your child’s spinal cord and canal doesn’t completely form in fetal development. Their spinal cord may be exposed and abnormally attached to their skin when they’re born.

In less severe forms, like spina bifida occulta, other congenital anomalies such as fatty tissue (lipoma) or a thickened band (thickened filum) at the end of their spinal cord can cause it to attach abnormally to the canal wall.

Children with spina bifida often have surgery early in life to untether their spinal cord. But scar tissue may form around it and reattach it to their spinal canal. As children grow, this can cause their spinal cord to stretch, which may lead to tethered spinal cord syndrome.

Who does tethered spinal cord syndrome affect?

Tethered spinal cord syndrome occurs most often in people who’ve had open spina bifida. Some experts estimate that up to 1 in 2 children with a history of myelomeningocele will develop tethered spinal cord syndrome. However, it’s important to understand that you can have a tethered spinal cord without having obvious spina bifida

What are the symptoms of a tethered spinal cord?

The symptoms of a tethered spinal cord can vary widely from person to person. Some babies have symptoms of a tethered spinal cord at birth. Most of the time, tethered cord symptoms develop in children as they grow. Rarely, others don’t have any symptoms in childhood but develop symptoms as adults if they were undiagnosed earlier.

In children and adults, tethered spinal cord syndrome may be associated with:

• Difficulty walking.
• Dimples, noncancerous (benign) tumors or patches of hair on your lower back.
• Discolored skin patches and hemangiomas, a type of birthmark.
• Numbness in your legs or back.
• Severe leg or back pain, often extending to your rectum or genital area.
• Scoliosis.
• Skin tags (acrochordons).
• Trouble with bladder and bowel control.
• Fluid-filled cysts in your spinal cord (syringomyelia).
• Loss of muscle mass (muscle atrophy).

What causes tethered spinal cord syndrome?

Tethered spinal cord syndrome can be present at birth (congenital) or it can develop later in life (acquired).

Congenital causes of tethered cord syndrome include:

• An abnormally thick filum terminale, the tissue between the tip of your spinal cord and your tailbone (sacrum).
• Spina bifida.

Acquired causes of tethered cord syndrome may include:

• Scar tissue that develops after spinal cord surgery.
• Infections.
• Severe spinal trauma.
• Tumors.

Some researchers believe people have genetic factors that make them more likely to develop spina bifida. Experts have found a link between genes and myelomeningocele. But they haven’t proven a link between genes and tethered cord syndrome.

How is a tethered spinal cord diagnosed?

A neurologist, a healthcare provider specializing in the brain, spinal cord and nerves, usually diagnoses a tethered spinal cord. They physically examine you or your child and ask about symptoms. They typically also use imaging tests such as:

• MRI: This is the most common test to diagnose a tethered spinal cord. It uses magnets and radio waves to look at your spinal cord, nerves and surrounding structures.
• Myelogram: Your provider injects a contrast dye into your thecal sac, the membrane that surrounds your spinal cord. Then, they use an X-ray to see if there’s tethering to your spinal canal.
• CT scan: This test uses specialized computers and X-rays to look inside your body. Neurologists may use a CT scan after a myelogram to watch how contrast dye flows around your spinal cord.
• Ultrasound: Your provider uses high-frequency sound waves to view the inside of your body. Your neurologist may use it to look at how your spinal cord moves within your spinal canal. This is used most commonly in young infants.

How is a tethered spinal cord treated?

Surgery is the main treatment for a tethered spinal cord. The type of surgery can vary depending on several factors, including:

• The thickness of your filum terminale.
• Where your spinal cord is tethered.
• Whether you’re an adult or child.

In general, a neurosurgeon, a healthcare provider specializing in brain and spine surgeries, performs tethered spinal cord surgery. First, they make an incision in your lower back. Then, they use surgical tools to gently remove scar tissue and detach your spinal cord from your spinal canal.

What happens after tethered spinal cord surgery?

You or your child can typically resume light activities shortly after surgery, but will need to avoid strenuous activity to allow the area to heal well. This is typically at least six to eight, weeks, but it ultimately depends on your surgeon’s recommendations.

Some people may need physical or occupational therapy to help regain function after surgery. The surgery is performed to prevent ongoing injury to nerves, but it’s unlikely to reverse nerve damage already done. Thus, some people might continue to have muscle weakness or motor control problems (movement issues) even after treatment.

How can I prevent a tethered spinal cord?

Tethered spinal cords aren’t preventable, but prompt treatment can increase your chance of reversing symptoms. See a healthcare provider right away if you or your child experience any symptoms of a tethered spinal cord.

What is the outlook for a tethered spinal cord?

People with tethered spinal cord syndrome typically live a normal lifespan if they have treatment. The sooner you get treatment for a tethered spinal cord, the better your chances of a full recovery. Some symptoms, like motor control problems (movement issues), numbness or weakness, may not go away, especially if you have surgery later in life.

Will my child or I need more than one surgery for a tethered spinal cord?

Most people need only one surgery to treat a tethered spinal cord. However, up to 1 in 5 children need more than one surgery. Tethered spinal cord symptoms usually increase or flare up during periods of growth. In those cases, children may need another surgery after significant growth spurts. Children ages 7 to 12 have the highest risk of needing repeat surgery.

What questions should I ask my healthcare provider?

If you or your child have a tethered spinal cord, or you think it’s possible, you may want to ask your healthcare provider the following questions:

• What are the early signs of a tethered spinal cord?
• What tests diagnose a tethered spinal cord?
• What are the treatment options for a tethered spinal cord?
• What are the chances that tethered spinal cord symptoms will return after treatment?

Can you live a normal life with a tethered spinal cord?

Yes. Many people who receive prompt treatment for a tethered spinal cord live a normal life and have a typical lifespan.

A note from Cleveland Clinic

A tethered spinal cord is when your spinal cord abnormally attaches to your spinal canal. Although it can be scary to learn that you or your child have a tethered spinal cord, prompt treatment can relieve and possibly even reverse symptoms. Tethered spinal cord is closely related to spina bifida, which is a congenital condition where your spinal cord or canal didn’t develop properly. Also, many children who have myelomeningocele surgery later develop a tethered spinal cord. Speak with your healthcare provider right away if you notice you or your child develop any symptoms of a tethered spinal cord.