What Is Tethered Cord Syndrome?

Tethered cord syndrome, otherwise known as tethered spinal cord syndrome, is a progressive neurological disorder that limits spinal mobility. It develops when tissue attachments form either at the base of the spine or where an injury occurred.

This article discusses the symptoms, causes, and treatment options for tethered cord syndrome.

What Are the Symptoms of Tethered Cord Syndrome?

Tethered cord syndrome can develop at birth or during fetal development but also occur later in life. Its symptoms may vary depending on when the condition develops and when it is diagnosed.

Symptoms of congenital tethered cord syndrome include:

• Lesions, patches of hair, dimples, or fatty tumors may develop on the lower back
• Deformities in the spine or feet
• Leg weakness
• Lower back pain
• Scoliosis, a sideways curvature of the spine
• Incontinence, involuntary urination or defecation 
• Skin tags
• Skin discoloration
• Hemangiomas, which are bright red tumor-like birthmarks
• Difficulty walking
• Leg pain and numbness
• Recurring urinary tract infections (UTIs)

If a person develops the condition in adulthood or after a spinal injury, they may experience other signs as well, such as:

• Constant and severe lower back and leg pain
• Rectal and genital pain
• Muscle weakness, wasting, or numbness
• Bladder and bowel issues such as incontinence, constipation, and an urgent need to urinate
• Tenderness along the spine in the lower back
• Cyst formation in the spinal cord
• Immobility and loss of movement
• Headaches
• Decreased motor function
• Stiffness in the back, neck, shoulders, or extremities
• A loss of sensitivity to feelings of hot and cold sensations
• Imbalance

What Causes Tethered Cord Syndrome?

Tissue can grow and attach to the spine. This causes constant friction and pulls the spine in unnatural ways, causing spinal cord damage that can lead to neurological and physical symptoms.

There are two types of causes: primary and secondary. Primary causes are often congenital (caused at birth) and occur during fetal development. Secondary causes typically develop later in life and result from spinal trauma or infection.

Primary causes of tethered cord syndrome include:

• Myelomeningocele (a severe form of spina bifida) or lipomyelomeningocele (a fat mass in the middle of the back that attaches and pulls on the spinal cord)
• A congenital deformity known as dermal sinus tract
• A split spinal cord during fetal development, known as diastematomyelia
• Benign fatty mass or tumors (lipomas)
• Thickening of the filum terminale, which is a fragile filament located near the tailbone 

Secondary causes can include:

• Infection
• The development of scar tissue in the back that connects to the spinal cord
• Spinal surgery complication
• Spinal trauma or injury

How Is Tethered Cord Syndrome Diagnosed?

After examining symptoms, the mainstay of the diagnostic process for tethered cord syndrome is magnetic resonance imaging (MRI). MRIs get an in-depth look at the tissues within the spine to see if there are any tethered attachments.

Other imaging tests may help with diagnosis, including:

• Myelogram, which is an X-ray of the spinal canal using a type of dye to show if there are areas of pressure on the spinal cord or nerves 
• Computed tomography (CT scan) following the myelogram to get a closer look at how the dye moves in the spinal area
• Ultrasound to take images of the spinal cord's movement

How Is Tethered Cord Syndrome Treated?

The first-line treatment for tethered cord syndrome is surgery. Surgery is designed to untether the tissue attachments to help restore movement in the spine and reduce the damage the condition causes. Surgery may also cut certain nerve roots to relieve symptoms of pain.

In some mild cases, monitoring may be favored over surgery if the symptoms are not severe and do not affect a person’s life significantly.

In children with tethered cord syndrome, monitoring will be necessary even after surgery. That is because the tissue may reattach as a child grows. The most likely ages at which tissue attachments return are between 5 and 9 years old.

Summary

Tethered cord syndrome occurs when tissue unnaturally attaches to the spine causing damage to the spine, nerves, and surrounding tissues. The condition can develop during fetal development, infancy, or later in life. In people born with tethered cord syndrome, it is likely caused by a birth defect or congenital issue. In adults, a secondary cause such as a tumor, injury, or the growth of scar tissue is most likely the culprit.

Medical providers rely on MRI and other imaging tests to diagnose the condition. To fix the tethered tissue, surgery is the mainstay of treatment. In less severe cases, medical providers may recommend the wait-and-see method, which involves monitoring for worsening symptoms before proceeding with surgery.

A Word From Verywell

Because tethered cord syndrome often happens at birth, having a child with the condition may be scary. The good news is that it is often highly treatable, and many people with the disorder live normal and healthy lives after surgery.

If you do have an infant presenting with signs of tethered cord syndrome, be sure to meet with your medical provider. The quicker they are diagnosed and receive treatment, the less likely they will suffer from any permanent damage.