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Tethered Spinal Cord

What is a tethered spinal cord?

A tethered spinal cord is a condition where the spinal cord is pulled down and stuck or fixed to the spinal canal. The spinal cord normally floats inside the spinal canal.

As a child grows, the cord must be able to move freely inside the canal. If her spinal cord is stuck down as she grows, it will stretch like a rubber band and symptoms will start developing.

Nerve damage can occur if this problem is not repaired. The surrounding blood vessels are often fixed down, too, so the spinal cord does not get enough blood. This also causes nerve damage.

Symptoms of nerve damage may include:

  • Back and leg pain
  • Weak and numb legs
  • Changes in bladder and/or bowel control.

We diagnose a tethered spinal cord with an MRI scan and by your child’s symptoms.

Who gets a tethered spinal cord?

A tethered cord most often occurs in children who have myelomeningocele or lipomyelomeningocele. Over time, the spinal cord becomes scarred to the original defect and it sticks (tethers).

A child with a tight filum terminale or dermal sinus tract can also have a tethered cord. This is because excess tissue or tight tissue is holding the end of the cord down as she grows.

What is your experience with tethered spinal cords?

Children have tethered spinal cords for a variety of reasons. Our neurosurgeons have a great deal of experience treating both tethered spinal cords and the underlying conditions that can cause them.

We know that permanent damage to a child’s spinal cord can result in loss of function if this problem is left untreated. We operate on about 40 to 50 children a year who have some form of tethered spinal cord.

What surgery do you use to treat tethered spinal cord?

The cord may be tethered or stuck down by scar tissue, fat, a tight filum terminale or dermal sinus tract or some other problem inside the spinal canal.

The neurosurgeon does a laminectomy to open the spine and the thecal sac around the spinal cord and nerve roots.

He then frees up the spinal cord by gently cutting (teasing) it away from the scar tissue or fat. This is done with a microscope.

Our neurosurgeons use sophisticated neuromonitoring to avoid the risk of further damaging your child’s nerves. This monitoring keeps watch on the nerves and muscles on the lower part of her body during surgery.

Sometimes we apply a patch to the covering of the spinal cord (the dura mater) to limit the risk of a cerebrospinal fluid leak.

Once a child has had surgery to repair her spinal cord (for example, because of a myelomeningocele) or had her spinal cord freed up (detethered), there is a 20 percent chance that the cord will tether again as she continues growing.

Some children need repeated surgeries to detether their spinal cord.