TETHERED CORD SYNDROME: 

Questions and Answers

Symptoms of Tethered Cord Syndrome:

Tethered Cord Syndrome (TCS) manifests with a range of symptoms that can vary in severity and presentation. Here are the common symptoms associated with TCS:

Back Pain:

• Chronic or intermittent pain in the lower back or along the spine is a common symptom of TCS. The pain may worsen with physical activity or changes in position and may be accompanied by muscle stiffness or spasms.

Neurological Symptoms:

• Weakness: TCS can cause weakness, particularly in the legs, which may affect mobility and coordination. Patients may experience difficulty walking or performing activities that require strength and balance.
• Numbness or Tingling: Numbness, tingling, or “pins and needles” sensations may occur due to TCS affecting spinal nerves.
• Bowel or Bladder Dysfunction: TCS can lead to dysfunction of the bowel and bladder, resulting in urinary or fecal incontinence.  Individuals may also experience difficulty urinating or emptying the bladder or constipation.

Orthopedic Symptoms:

• Scoliosis: The abnormal tethering of the spinal cord can cause changes in spinal alignment, leading to the development of scoliosis.
• Foot Deformities: In some cases, TCS patients may also experience foot deformities — clubfoot or pes cavus (high-arched foot).  This occurs due to abnormal nerve signals affecting muscle function in the lower extremities.

Skin Changes:

• Cutaneous Stigmata: Certain physical signs, known as cutaneous stigmata, may exist in individuals with TCS. These may include areas of hyperpigmentation, dimpling, or hair patches over the lower back, which indicate underlying spinal abnormalities.

Motor Dysfunction:

• Muscle Weakness: Patients with TCS may experience weakness or atrophy in the muscles of the lower extremities. This leads to difficulties with walking, running, or other motor tasks.
• Gait Abnormalities: Changes in gait, such as a wide-based or unsteady walk, may occur due to muscle weakness.  Sensory deficits or alterations in balance and coordination may also occur because of TCS.

Other Symptoms:

• Tethering Syndrome Symptoms: Some patients with TCS may develop additional symptoms associated with tethering syndrome.  These symptoms are progressive neurological deficits, pain, or discomfort exacerbated by stretching or straining.

Overall, the symptoms of Tethered Cord Syndrome can vary widely among individuals and may worsen over time without proper intervention. Early recognition and treatment are essential for managing symptoms and preventing complications associated with TCS.

Diagnosis of Tethered Cord Syndrome:

Diagnosing Tethered Cord Syndrome (TCS) involves a comprehensive evaluation that includes medical history, physical examination, and diagnostic imaging studies. Here is an overview of the diagnostic process for TCS:

Medical History:

• The doctor begins by taking a detailed medical history, including any symptoms the patient is experiencing.  The doctor is interested in the duration of symptoms and any factors that exacerbate or alleviate the symptoms. A family history of spinal abnormalities or neurological conditions may also be relevant.

Physical Examination:

• A thorough physical examination is conducted to assess neurological function, musculoskeletal abnormalities, and signs of spinal cord tethering. The doctor may evaluate muscle strength, sensation, reflexes, gait, and coordination to identify any neurological deficits indicative of TCS.

Imaging Studies:

• Magnetic Resonance Imaging (MRI): MRI is the primary imaging modality used to diagnose TCS. It provides detailed images of the spinal cord, nerve roots, and surrounding structures, allowing the doctor to visualize any abnormalities.  In this case, the abnormalities are tethering of the spinal cord, spinal cord syrinx (cyst), or structural anomalies.
• Tethered Cord Protocol MRI: In some cases, doctors will use a specialized MRI protocol known as the tethered cord protocol MRI.  These scans will allow the doctor to assess the extent of spinal cord tethering and associated abnormalities more accurately.
• Computed Tomography (CT) Scan: Doctors will use CT scans to evaluate bony abnormalities of the spine, such as vertebral malformations or spinal canal narrowing.  These findings can contribute to spinal cord tethering.

Electrodiagnostic Testing:

• Electromyography (EMG) and Nerve Conduction Studies (NCS): Doctors will use these tests to assess nerve function and identify any abnormalities in nerve conduction or muscle activity. EMG involves measuring electrical activity, while NCS measures the speed and strength of nerve signals.

Urodynamic Studies:

• Doctors will use urodynamic studies to assess bladder function and determine if there are any abnormalities. Urinary retention, incontinence, or detrusor overactivity can be associated with TCS-related neurogenic bladder dysfunction.

Other Tests:

• Doctors will use additional tests, such as blood tests or genetic testing, to rule out other conditions.  These tests will also identify underlying TCS genetic factors.  Particularly in cases where there is a family history of spinal abnormalities or congenital disorders.

By combining information from the medical history, physical examination, and diagnostic tests, doctors can accurately diagnose Tethered Cord Syndrome.  Doctors can then develop an appropriate treatment plan tailored to the individual patient’s needs. Early diagnosis is crucial for preventing complications and optimizing outcomes in patients with TCS.

Non-Surgical Treatment for Tethered Cord Syndrome:

In some cases, tethered cord syndrome may not require surgery, particularly if the symptoms are mild and not progressing. Physicians might recommend a “watch and wait” approach, which involves closely monitoring the symptoms over time to see if they change or worsen. This approach allows for a careful assessment of the condition, potentially avoiding unnecessary surgery.

While waiting might cause some stress for you and your family, it’s important to understand that this measured approach contributes to a high safety record and can be beneficial in the long term. During this period, non-surgical treatments can help manage symptoms and improve quality of life. These might include the following for chronic or intermittent pain.

• Pain medication: Over-the-counter pain relievers or prescription medications can help manage pain.
• Physical therapy: Physical therapy exercises can help improve flexibility, strength, and coordination.
• Bracing: In some cases, a back brace might be used to provide support and stability.

By taking this methodical approach, you ensure that any decisions regarding surgery are well-informed and only pursued when necessary. This strategy prioritizes safety and aims to maintain the best possible quality of life during the observation period.

Surgical Treatment for Tethered Cord Syndrome:

Surgical treatment for Tethered Cord Syndrome (TCS) aims to release the tethered spinal cord.  This action will alleviate symptoms by correcting the underlying anatomical abnormality. The specific surgical approach depends on various factors, including the severity of symptoms and the location of the tethering.  It will also reveal the presence of associated spinal anomalies. Here are the main surgical procedures used to treat TCS:

Tethered Cord Release Surgery:

• The primary TCS surgical intervention involves releasing the tethered spinal cord to relieve tension and restore normal spinal cord mobility. This procedure is typically performed under general anesthesia.
• The surgeon makes an incision in the back of the abdomen to access the affected area of the spinal cord.
• Using microsurgical techniques, the surgeon carefully detaches the adherent tissues or structures that are tethering the spinal cord.  This will allow the spine to move freely within the spinal canal.
• In some cases, additional procedures may be performed simultaneously to address associated spinal abnormalities.  For example, spinal cord syrinx (cyst) drainage, spinal cord untethering, or spinal fusion to stabilize the spine.

Endoscopic Tethered Cord Release:

• Endoscopic surgery may be used as a minimally invasive spine surgery alternative to traditional open surgery for selected cases of TCS. This technique involves inserting a thin, flexible tube with a camera (endoscope) to visualize and release the tethered spinal cord.
• Endoscopic tethered cord release offers several potential advantages over traditional open surgery.  These include reduced tissue trauma, shorter hospital stays, and faster recovery time. However, not all patients are candidates for this approach, and its efficacy may vary.  It all depends on the specific characteristics of the tethered cord.

Spinal Cord Detethering with Spinal Fusion:

• In cases where there is significant instability of the spine or spinal deformities.  Spinal cord untethering may be combined with spinal fusion surgery to provide additional stability and prevent recurrent tethering.
• Spinal fusion involves fusing adjacent vertebrae using bone grafts, screws, rods, or other instrumentation.  This procedure will immobilize the spine and promote fusion. This helps maintain the correct alignment of the spinal column and reduces the risk of recurrent tethering.

Postoperative Monitoring and Rehabilitation:

• Following surgery, patients with TCS require close postoperative monitoring to assess neurological function, wound healing, and symptom resolution.
• Rehabilitation includes physical therapy, occupational therapy, and other supportive measures to optimize recovery, restore mobility, and improve quality of life.

The choice of surgical technique depends on various factors:

• The underlying cause of TCS.
• The extent of spinal cord tethering is needed because of the presence of associated spinal abnormalities.
• The patient’s overall health and treatment goals.

Patients need to discuss the available surgical options with their healthcare team to make informed decisions about their treatment plans.

Benefits of Surgical Treatment for Tethered Cord Syndrome:

Surgical treatment for Tethered Cord Syndrome (TCS) offers several potential benefits for patients experiencing symptoms related to spinal cord tethering. These benefits may vary depending on the individual patient’s condition and the specific surgical approach employed. Here are some of the key benefits of surgical treatment for TCS:

Symptom Relief:

• One of the primary goals of surgical treatment for TCS is to alleviate symptoms associated with spinal cord tethering. By releasing the tethered spinal cord and restoring normal spinal cord mobility, surgery can help relieve symptoms such as back pain, leg weakness, sensory disturbances, bladder or bowel dysfunction, and gait abnormalities.

Prevention of Neurological Complications:

• TCS can lead to progressive neurological deficits and complications if left untreated, including permanent nerve damage, loss of motor function, and deterioration of bladder and bowel function. Surgical intervention aims to prevent or minimize these complications by addressing the underlying cause of spinal cord tethering and relieving pressure on the spinal cord.
• Improved Quality of Life:
• By relieving symptoms and preventing neurological complications, surgical treatment for TCS can significantly improve patients’ overall quality of life. Patients may experience enhanced mobility, reduced pain, improved bladder and bowel function, and greater independence in daily activities following surgery.

Prevention of Progression:

• In some cases, TCS may worsen over time if left untreated, leading to irreversible neurological damage and functional impairment. Surgical intervention can halt or slow down the progression of TCS by releasing the tethered spinal cord and addressing any associated spinal abnormalities, thereby preserving neurological function and preventing further deterioration.

Enhanced Long-Term Outcomes:

• Studies have shown that early surgical intervention for TCS is associated with better long-term outcomes compared to delayed or conservative management. By addressing the underlying pathology and releasing the tethered spinal cord promptly, surgery can optimize neurological recovery and functional outcomes for patients with TCS.

Reduced Risk of Recurrence:

• While recurrence of tethered cord syndrome is possible following surgery, particularly in cases of congenital or complex tethering, surgical treatment can significantly reduce the risk of recurrence compared to conservative management. Surgeons may employ various techniques, such as meticulous dissection and spinal cord detethering, to minimize the risk of recurrent tethering and improve long-term outcomes.

Overall, surgical treatment for TCS offers the potential for symptom relief, prevention of neurological complications, improved quality of life, and enhanced long-term outcomes for patients with this condition. Patients need to discuss the potential benefits and risks of surgery with their healthcare providers to make informed decisions about their treatment options.

Complication Prevention

Preventing complications from surgery involving tethered cord syndrome (TCS) requires careful preoperative planning, meticulous surgical technique, and comprehensive postoperative management. While complications cannot always be eliminated, several strategies can help minimize their occurrence and optimize patient outcomes:

Pre-Surgery Check

A full check before surgery is key to assessing the patient’s health, spotting any existing issues or odd spine shapes that could raise risks, and improving the patient’s condition. For example, this may include detailed nerve tests, scans like MRI or CT, and lab tests to check spinal cord tethering and nerve function.

Surgery Planning

Careful surgery planning is vital for good results and fewer issues during TCS surgery. First, surgeons must review pre-surgery scans to find where and how much the spinal cord is tethered, plan the approach, and prepare for possible challenges or spine differences. Also, using advanced scans and real-time monitoring helps guide decisions and ensures safe cord untethering.

Precise Surgery Methods

During surgery, precise techniques are crucial to limit tissue harm, protect nerve function, and fully untether the spinal cord without hurting nearby nerves. Surgeons must be cautious when cutting around the tethered cord, gently find and free tether points, and use fine tools to reduce tissue handling and boost accuracy.

Real-Time Monitoring

Real-time nerve monitoring (IONM) is key to catching possible nerve issues during TCS surgery. By tracking nerve function, like motor and sensory signals, muscle activity, and spinal cord blood flow, IONM lets surgeons check the spinal cord and nerve roots live. As a result, they can adjust techniques to avoid nerve harm.

Post-Surgery Care

Thorough care after surgery is essential to watch for early signs of issues, manage pain, prevent infection, and aid nerve healing. Patients need close watch right after surgery, with frequent nerve checks, vital sign tracking, and pain relief. Plus, early movement, physical therapy, and rehab programs may start to speed healing and prevent problems like blood clots or muscle loss.

Patient Education and Follow-Up

Teaching patients and families about signs of possible issues and the need to follow post-surgery rules and attend checkups is vital for good results. Patients should quickly report new or worsening symptoms. Also, regular visits with the surgery team are needed to track long-term results and handle any issues that come up.

Conclusion

By using these careful steps and a team-based care approach, doctors can lower surgery risks for tethered cord syndrome and improve patient outcomes. Patients should talk about risks and concerns with their doctors and take part in pre- and post-surgery care to get the best outcomes.

Recovering from Tethered Cord Syndrome

The healing time after surgery for tethered cord syndrome (TCS) varies based on factors like the condition’s severity, surgery type, patient’s health, and any issues that arise. Each patient’s recovery is unique, but here’s a general timeline for the healing process:

Hospital Stay (Right After Surgery)

After TCS surgery, patients stay in the hospital for close watch and care. Typically, this lasts a few days to a week, depending on the surgery’s complexity and the patient’s progress. During this time, doctors check nerve function, pain levels, and wound healing. They may also give pain relief drugs and start gentle movement as the patient can handle.

Early Healing (First Few Weeks)

Once home, patients enter early recovery, regaining strength and movement bit by bit. Some pain or unease at the surgery site is normal, but doctors can provide pain drugs to help. For now, patients should avoid hard tasks or lifting heavy items and follow their surgery team’s advice.

Mid-Term Healing (Weeks to Months)

As initial pain fades, patients move to mid-term recovery, focusing on rehab and slowly increasing activity. Physical therapy may start to boost strength, flexibility, and movement, while addressing any nerve issues. Also, patients may have follow-up visits with their surgery team to track progress, fix concerns, and tweak the treatment plan as needed.

Long-Term Healing (Months to Years)

Long-term recovery can last months to years, with patients working to improve function, movement, and life quality. Depending on nerve damage and surgery success, some may see ongoing nerve improvements, while others need continued care for lasting symptoms or issues. Regular doctor visits are key to check outcomes, handle problems, and offer support.

Key Steps for Recovery

Patients must follow their doctor’s advice for post-surgery care, including taking prescribed drugs, following activity limits, doing therapy exercises, and attending follow-up visits. By staying active in their recovery and sticking to the plan, patients can improve their chances of a good outcome, regaining nerve function, and enjoying a better quality of life.

Know when to Get a Second Opinion

If you or a loved one has tethered cord syndrome, a second opinion can bring clarity and calm. For example, it ensures the treatment plan fits your needs well.

Find a Skilled Expert

First, look for doctors who specialize in tethered cord syndrome or nerve issues. Seek neurosurgeons or neurologists with strong experience. Also, top hospitals often have experts who can offer a second opinion.

Use Online Consults

If travel is hard or you want ease, many doctors provide virtual visits via computer or phone. This makes getting advice simpler.

Check Insurance

Before booking a consult, call your health insurance. Confirm if a second opinion is covered and learn about any costs.

Prepare for the Visit

Gather all key medical records, like scans, lab results, and current treatment plans. Having these ready helps make the consult useful.

Book the Appointment

After these steps, set up your visit with confidence. Whether in-person or online, this talk can give helpful insights or confirm your diagnosis and plan.

Conclusion

By taking these steps, getting a second opinion for tethered cord syndrome becomes clear and easy.

Why Choose the Southwest Scoliosis and Spine Institute

Patients seeking treatment for Tethered Cord Syndrome should consider the Southwest Scoliosis and Spine Institute for several compelling reasons. Led by renowned spine surgeons, Doctors Richard A. Hostin, Devish Ramnath, and Ishaq Syed, this institute boasts a team of experts specializing in complex spinal conditions, including Tethered Cord Syndrome. With offices conveniently located in Dallas, Plano, and Frisco, Texas, patients have access to cutting-edge diagnostic and treatment facilities close to home.

The institute is known for its patient-centered approach, where individualized care plans are tailored to meet each patient’s unique needs and preferences. Moreover, the institute offers comprehensive services, including state-of-the-art surgical treatments, nonsurgical interventions, and post-operative rehabilitation, ensuring holistic care throughout the treatment journey. Patients can trust in the expertise and experience of the spine surgeons at the Southwest Scoliosis and Spine Institute, backed by a track record of successful outcomes and a commitment to providing the highest quality of care.

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Citation: American Association of Neurological Surgeons – Tethered Cord Syndrome

The medical content on this page has been carefully reviewed and approved for accuracy by the Southwest Scoliosis and Spine Institute’s qualified healthcare professionals, including our board-certified physicians and Physician Assistants. Our team ensures that all information reflects the latest evidence-based practices and meets rigorous standards of medical accuracy, with oversight from our expert spine doctors to guarantee reliability for our patients.