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 by 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 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. Non-surgical treatments can help manage symptoms and improve quality of life. These might include:

• 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.

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 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:

Preoperative Evaluation:

• Thorough preoperative evaluation is essential to assess the patient’s overall health status, identify any preexisting medical conditions or anatomical anomalies that may increase the risk of complications, and optimize the patient’s medical condition before surgery. This may involve conducting comprehensive neurological assessments, imaging studies (such as MRI or CT scans), and laboratory tests to evaluate spinal cord tethering and assess the patient’s neurological function.

Surgical Planning:

• Surgical planning is critical to ensure optimal outcomes and minimize the risk of complications during TCS surgery. Surgeons should carefully review preoperative imaging studies to identify the location and extent of spinal cord tethering, plan the surgical approach, and anticipate potential challenges or anatomical variations. Using advanced imaging techniques and intraoperative monitoring modalities can help guide surgical decision-making and ensure safe and effective untethering of the spinal cord.

Meticulous Surgical Technique:

• During surgery, meticulous surgical technique is essential to minimize tissue trauma, preserve neurological function, and achieve complete untethering of the spinal cord while avoiding damage to surrounding neural structures. Surgeons should exercise caution when dissecting around the tethered cord, carefully identify and release the tethering points, and employ microsurgical techniques to minimize tissue manipulation and maximize surgical precision.

Intraoperative Monitoring:

• Intraoperative neurophysiological monitoring (IONM) plays a crucial role in detecting potential neurological complications during TCS surgery. By continuously monitoring neurological function, including motor and sensory evoked potentials, electromyography (EMG), and spinal cord blood flow, IONM allows surgeons to assess the integrity of the spinal cord and nerve roots in real time and adjust surgical techniques accordingly to prevent neurological injury.

Postoperative Care:

• Comprehensive postoperative care is essential to monitor patients for early signs of complications, manage pain, prevent infection, and facilitate neurological recovery. Patients should receive close monitoring in the immediate postoperative period, including frequent neurological assessments, vital sign monitoring, and pain management. Early mobilization, physical therapy, and rehabilitation programs may also be initiated to promote recovery and prevent complications such as deep vein thrombosis (DVT) and muscle atrophy.

Patient Education and Follow-up:

• Educating patients and their families about the signs and symptoms of potential complications, as well as the importance of adhering to postoperative instructions and attending follow-up appointments, is crucial for ensuring optimal postoperative outcomes. Patients should be encouraged to report any new or worsening symptoms promptly, and regular follow-up visits with the surgical team should be scheduled to monitor long-term outcomes and address any concerns or complications that may arise.

By following these preventive measures and adopting a multidisciplinary approach to patient care, healthcare providers can minimize the risk of complications from surgery involving tethered cord syndrome and optimize patient outcomes. Patients need to discuss their risks and concerns with their healthcare providers and actively participate in their preoperative preparation and postoperative care to ensure the best possible results.

Recovering from Tethered Cord Syndrome

The recovery period for individuals undergoing surgery for tethered cord syndrome (TCS) can vary depending on several factors, including the severity of the condition, the type of surgical procedure performed, the patient’s overall health, and the presence of any complications. While each patient’s recovery experience is unique, a general timeline for the recovery process following TCS surgery may include the following phases:

Immediate Postoperative Period (Hospital Stay):

• Following TCS surgery, patients typically remain in the hospital for observation and monitoring in the immediate postoperative period. The length of hospitalization can vary but is often several days to a week, depending on the complexity of the surgery and the patient’s postoperative course. During this time, healthcare providers closely monitor the patient’s neurological function, pain levels, and wound healing, and may administer pain management medications and initiate early mobilization as tolerated.

Early Recovery Phase (First Few Weeks):

• Upon discharge from the hospital, patients enter the early recovery phase, during which they continue to recover from surgery and gradually regain strength and mobility. Patients may experience some discomfort or pain at the surgical site, which can be managed with pain medications prescribed by their healthcare provider. During this phase, patients may be advised to avoid strenuous activities and lifting heavy objects and to follow any specific postoperative instructions provided by their surgical team.

Mid-Term Recovery Phase (Several Weeks to Months):

• As the initial postoperative discomfort resolves, patients typically transition to the mid-term recovery phase, during which they continue to focus on rehabilitation and gradually increase their activity levels. Physical therapy and rehabilitation may be initiated to help improve strength, flexibility, and mobility, as well as to address any residual neurological deficits. Patients may also undergo periodic follow-up appointments with their surgical team to monitor their progress, address any concerns or complications, and adjust their treatment plan as needed.

Long-Term Recovery and Rehabilitation (Months to Years):

• The long-term recovery and rehabilitation phase can extend for several months to years, during which patients continue to work on improving their physical function, mobility, and overall quality of life. Depending on the extent of neurological damage and the success of surgical intervention, some patients may experience ongoing neurological improvements over time, while others may require ongoing management of residual symptoms or complications. Regular follow-up appointments with healthcare providers are essential during this phase to monitor long-term outcomes, address any ongoing issues, and provide ongoing support and guidance.

It is essential for patients undergoing surgery for TCS to follow their healthcare provider’s recommendations for postoperative care, including any prescribed medications, activity restrictions, physical therapy exercises, and follow-up appointments. By actively participating in their recovery process and adhering to their treatment plan, patients can optimize their chances of achieving a successful outcome and returning to their usual activities with improved neurological function and quality of life.

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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American Association of Neurological Surgeons: Tethered Cord Syndrome