Unraveling Tethered Spinal Cord: Key Symptoms, Diagnostic Approaches & Treatment Solutions
What is Tethered Spinal Cord?
A tethered spinal cord, often abbreviated as TSC, is a neurological disorder in which the spinal cord becomes attached (or “tethered”) to the spine. This can limit the movement of the spinal cord within the spinal column. A normally positioned spinal cord is free to move up and down within the spinal canal, adjusting to the motions and growth of the body. In a person with TSC, however, this movement is restricted. As a result, the spinal cord experiences undue stretching, leading to a host of potential complications.
Causes of Tethered Spinal Cord
The tethering is usually caused by abnormal tissues—like bands of scar tissue—that hold the spinal cord at the base of the spinal column. This condition can be congenital (present at birth) or develop later in life due to injury, tumors, or post-operative scarring.
Symptoms and Diagnosis
The symptoms of a tethered spinal cord can vary widely among patients, depending on the severity of the condition and the level at which the spinal cord is tethered.
Symptoms may include:
- Back pain or leg pain
- Weakness or numbness in the legs
- Tethered cord syndrome in children can also lead to developmental delays in walking or bowel and bladder control.
- Deformities of the spine, like scoliosis
- Skin abnormalities over the lower back include hairy patches, dimples, or fatty tumors.
Treatment Options for Tethered Spinal Cord
Doctors usually start with a detailed medical history and physical examination to diagnose a tethered spinal cord. Imaging tests, like MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scans, can confirm the diagnosis by providing detailed images of the spinal cord, tissues, and bones.
Surgical Interventions
When symptoms are severe or progressing, surgery is usually recommended. The primary aim of the surgery is to release the tethered spinal cord, allowing it to move freely within the spinal canal. Here are the main surgical options available:
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- Laminectomy: In this procedure, a portion of the vertebral bone (lamina) is removed to access the tethered cord. Once accessed, the surgeon carefully releases the cord from its abnormal attachments.
- Sectioning of the Filum Terminale: In some patients, the filum terminale—a thin, fibrous strand connecting the base of the spinal cord to the lower end of the spine—becomes thickened and contributes to the tethering. By sectioning or cutting this strand, the spinal cord can be released.
- Removal of Lipomas: Lipomas (fatty tumors) can sometimes cause tethering. In such cases, removing the lipoma can free the cord.
- Spinal Detethering with Tumor Resection: If a spinal tumor is the cause of the tethering, the tumor can be removed to release the cord. This is a more complex surgery, requiring expertise in tumor resection and spinal cord detethering.
- Revision Surgeries: In some cases where tethering reoccurs after a primary surgery, a revision surgery may be required to release the cord again.
Postoperative Care and Follow-Up
Post-operative care and recovery time will vary depending on the surgical procedure and the patient’s general health. Physical therapy is often recommended to help with muscle strength and mobility. Regular follow-ups with the neurosurgeon are critical to monitor the healing process and ensure that there’s no recurrence of the tethering.
While surgical interventions for tethered spinal cord can offer immediate relief and improved quality of life, it is essential to understand that patients might require long-term monitoring.
- Re-tethering: One of the most significant concerns after surgery is the potential for re-tethering. As the body heals, there’s a possibility for scar tissue to form, which can result in the spinal cord becoming tethered again.
- Neurological Follow-up: Regular neurological check-ups are vital. These evaluations can track any changes in strength, sensation, and function, ensuring early detection if problems re-emerge.
- Physical Rehabilitation: While many patients experience a swift return to regular activities post-surgery, some might need continued physical therapy. This rehabilitation can help maintain and improve muscle strength, coordination, and overall mobility, especially if the tethered cord led to muscular weaknesses or gait abnormalities.
- Continence Issues: Tethered spinal cord can sometimes cause bowel and bladder problems. Even after surgical intervention, some patients might continue to face challenges with continence. Urological evaluations and interventions can be beneficial, including biofeedback and pelvic floor exercises.
- Psychological Support: Dealing with a neurological condition can be mentally taxing. Psychological counseling or therapy sessions can help patients cope with their condition’s emotional and psychological aspects, fostering a healthier state of mind.
- Routine Imaging: Regular MRIs or CT scans can be recommended, especially in the initial years after surgery. These images can help assess the condition of the spinal cord and surrounding tissues and detect early signs of re-tethering or other complications.
While some cases of tethered spinal cord are congenital and cannot be prevented, understanding the potential causes of acquired tethering can be beneficial. For instance, being aware of the risks associated with certain types of back surgeries or injuries can prompt individuals to seek timely evaluations if symptoms emerge.
A tethered spinal cord is a serious condition that can lead to various complications if left untreated. With the right diagnosis and timely surgical intervention, many patients experience significant relief from symptoms and lead a normal, healthy life. If you suspect a tethered spinal cord, it’s essential to consult a neurosurgeon for a thorough evaluation and appropriate treatment.
For a comprehensive evaluation and to explore your treatment options, don’t hesitate to schedule an appointment or seek a second opinion consultation with Dr. Scott Raffa at Cantor Spine Center at the Paley Orthopedic & Spine Center by calling 561-935-1188. Take the first step towards a pain-free life by calling us today.