Tethered Spinal Cord Syndrome: What You Need To Know
Tethered Spinal Cord Syndrome
Considered the highway for neurological information, the spinal cord is a major part of the central nervous system that functions as a channel for motor information, sensory information, and as a center for coordinating certain reflexes. Connected to the brain, it descends down the middle of the back, connecting the brain and peripheral nervous system. The functions of most of the important human body systems are both directly and indirectly dependent on the spinal cord. Hence, injuries and other physical diseases involving this part of the central nervous system may result to conditions that may affect a range of motor, sensory and autonomic nervous system functions.
Among the most popular diseases affecting the spine is the tethered spinal cord syndrome or TSCS, a neurological condition that is characterized by the fastening of the spine to the column. It is generally a result of a growth of tissues at the end of the spine. These tissues attach the spinal cord to the surrounding tissues of the spinal column, hence, limiting the cord’s movement and forcing it to stretch as the body grows or moves.
TSCS is a disease that often results from a congenital malformation where the neural tube is improperly developed at the time of fetal development. It also is usually an after-effect of birth defects like myelomeningoceles, lipomyelomeningoceles or the growth of fatty tumors at the lower end of the spine, and split cord malformation. Nonetheless, infants and older children may also acquire this condition as a result of damages to the spine, fatty skin masses that grow into the spine, and past surgeries involving the spine.
TSCSis a disease that often goes undiagnosed until adulthood. Nonetheless, various symptoms of this condition present themselves at different times through the child’s growth. An unusual dimple, discoloration or patch of hair in the lower part of the back, raised lump, and abnormal structure of the genital organs and the anus are the most common symptoms of TSCS among newborns. On the other hand, symptoms of this condition among children and other older patients include severe pains in the lower back, numbness or weakness in the feet or legs, and loss of feeling and movement in lower extremities.
In general, symptoms of the presence of TSCS are both physical and behavioral. As observed, most of the physical symptoms such as hairy patches, discolorations on the lower back, spinal deformities, and unequal leg sizes are already visible from childbirth to adolescent years. However, most behavioral indicators of TSCS like the progressive loss of control over functions of the bladder and bowel, muscle contractions, sensory and motor problems, and weakness in the legs often manifest in adulthood—a period where there has already been a massive stretch on the spinal cord.
The effects of TSCS vary depending on the cause of tethering and the amount of affected tissues in the areas surrounding the spine. Among children, the condition may cause foot deformities, developmental delays, and back pains. In adults, on the other hand, it can cause bladder and bowel incontinence, sensory problems, and weakness in the legs. It may also result to medical conditions such as constipation and diarrhea. Difficulty with sexual relations is also observed among individuals suffering from TSCS. Moreover, severe and acute cases of the disease may result to kidney stones, renal failure, and, among female patients, ineffective labor and postpartum rectal prolapse.
TSCS is a disease that can be reversible especially if diagnosed and treated in its early stage. Today, various procedures are being employed to confirm a suspected tethered cord. Among these is the magnetic resonance imaging (MRI) of the lumbar spine. This procedure provides a three-dimensional image of the spinal cord, nerve roots, and surrounding areas, and hence, diagnosing the location of the tethering. Other procedures employed today in the diagnosis of TSCS include electromyography, computed tomography scan (CT scan), and ultrasound.
Treating tethered spinal cord syndrome
Tethered spinal cord syndrome can be treated in various ways. Among children, the best and only treatment for the disorder is surgery. Generally taking four to six hours and is conducted according to the form of TSCS in the patient, surgery acts to detach the spinal cord at its place of tethering—i.e., the cord is freed from the tissues binding it. Though uncommon among adults, surgery, if done in a timely manner, may also reverse most of the damages of TSCS. Surgery among adult patients is also often employed to reduce, if not prevent, the development and growth in the spinal cord of lumps.
Though surgery can release the tethered spinal cord, and hence, allowing children and adults a full and normal life, relief from pain and further problems, motor damages and neurological problems caused by TSCS are often permanent. Hence, rehabilitation programs following a surgery such as leg and spine braces, bowel and diet training, and, in severe cases, artificial sphincter incorporation or catheterization are often required.
Moreover, it is also not uncommon that a treated cord reattaches itself to the column—i.e., re-tethering. Recurrent tethering is most common among babies because of their shallow spinal canal. As such, regular follow-ups are essential following a surgery. Symptomatic and supportive treatments are also often necessary in the treatment of TSCS.
Nonetheless, there are also some cases of TSCS that do not require full surgery. Instead, an operation is performed to cut the spinal cord’s nerve roots to alleviate the pain and discomfort of the syndrome. This procedure is often done for those with tight or short filum terminale. On the contrary, a more complex surgery is often employed for TSCS caused by a congenital abnormality or a tumor. However, in instances where surgery cannot detach the spinal cord from the spinal column, follow-up check-ups are mandatory to prevent lesions and cysts from developing along the spinal cord.
Tethered spinal cord syndrome, just like other congenital birth defects, is often inevitable. Nonetheless, this condition is definitely curable, though not completely irreversible. That is, patients with this condition may expect to live a normal and healthy life if and when promptly treated.
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