Tethered Cord Syndrome is a condition characterized by abnormal stretching or compression of nerve fibers in the spinal cord. This syndrome can occur due to various reasons such as spinal cord injuries, tumors, inflammation, or infections in the tissues surrounding the spinal cord. It can be managed with timely diagnosis and appropriate treatment, but if left untreated, it can lead to serious complications.
What is Tethered Cord Syndrome?
Tethered Cord Syndrome (TCS) is characterized by abnormal stretching of the spinal cord within the spinal canal. Normally, the spinal cord can move freely along the spine, but in TCS, the lower part of the spinal cord becomes tethered to various tissues (spinal bones, fatty tissue, etc.). This tethering disrupts the natural position and function of the spinal cord, leading to neurological and physical problems. This syndrome is often congenital and diagnosed in childhood, but in some cases, symptoms may appear in adulthood.
Symptoms of Tethered Cord Syndrome
Symptoms of Tethered Cord Syndrome typically manifest in childhood but can also occur in adults:
- Pain: Constant or intermittent pain in the back and legs.
- Motor Weakness: Weakness in the feet and legs, difficulty in movement.
- Gait Abnormalities: Abnormal walking patterns such as limping or a low-lying ankle.
- Neurological Dysfunction: Bladder and bowel control problems like urinary and fecal incontinence.
- Spinal Deformities: Spinal curvatures like scoliosis.
- Sensory Issues: Numbness or tingling in the feet and legs.
- Skin Abnormalities: Increased hair growth, fatty deposits, skin indentations, or moles in the lower back area.
Causes of Tethered Cord Syndrome
Several different factors can cause Tethered Cord Syndrome:
- Spinal Cord Injuries: Accidents or injuries that damage the spinal cord can lead to TCS.
- Spinal Deformities: Abnormalities in the bones or tissues surrounding the spinal cord can compress it and cause TCS.
- Tumors: Tumors in the spinal cord or surrounding tissues can compress the spinal cord or exert pressure on nerve fibers, leading to TCS.
- Infections: Infections affecting the spinal cord or surrounding tissues can cause inflammation and swelling, compressing the spinal cord and causing TCS.
- Cystic Fibrosis: Genetic disorders like cystic fibrosis can lead to fluid accumulation in the spinal cord and compression of nerve fibers.
- Spinal Stenosis: Narrowing of the spinal canal can compress nerve roots and cause TCS.
Diagnosis and Tests
Primary methods used for diagnosis include:
- Magnetic Resonance Imaging (MRI): Provides detailed images of the spinal cord and surrounding areas, showing tethering and compression.
- Ultrasound: Particularly used in infants to evaluate the condition of the spinal cord.
- Electrophysiological Tests: Used to evaluate nerve functions.
- Urodynamic Testing: Can be performed to evaluate bladder functions.
Treatment Methods
Surgical Treatment:
- Untethering Surgery: Releases the tethered spinal cord to reduce symptoms and prevent progressive neurological damage. The specific surgical approach depends on the cause of the tethering. Thickened filum terminale is usually cut to relieve tethering. It is typically performed in symptomatic patients and in the early stages.
Supportive Therapies:
- Physical Therapy and Rehabilitation: Aims to increase muscle strength and improve motor functions and coordination.
- Orthopedic Supports: Used to support walking and daily activities.
Regular Monitoring:
- Postoperative and Long-term Follow-up: Regular neurological and physical examinations should be conducted after surgery and in the subsequent periods.
Tethered Cord Syndrome is a serious condition that can lead to various neurological and physical problems if left untreated. However, with early diagnosis and effective treatment, patients can lead a normal or near-normal life. A multidisciplinary approach and regular medical follow-up enhance treatment success and significantly improve patients’ quality of life.