Spinal Cord Tethering

The term tethered spinal cord refers to any condition in which the spinal cord is attached to an immovable structure. Normally the bottom of the spinal cord, called the conus medullaris, floats freely within a pool of spinal fluid. There are, however, an array of pathologic conditions that cause tethering of the cord. This leads to abnormal stretching with growth and movement, which over time can lead to the characteristic symptoms of tethered spinal cord, including muscle weakness, sensory loss, change in bowel or bladder control, and orthopedic deformity.

What causes spinal cord tethering?
The causes of tethered spinal cord are, for the most part, errors in normal development of the fetus. Many of these errors occur even before a woman knows that she is pregnant. Folate supplements for women in child bearing years can reduce the rate of some problems, such as open spina bifida, but many causes of tethered spinal cord seem unaffected by folate. In fact, with increased awareness of this condition and its symptoms, and more sensitive MRI scanning, more tethered cords are being detected than ever before. The primary causes of tethered spinal cords include the following conditions: dermal sinus tract, diastematomyelia (split spinal cord), lipoma, tumor, myelomeningocele ("spina bifida"), and tight filum terminale. Other cause can include past trauma or surgery on the spine.

Children with tethered spinal cord are diagnosed in many ways. The most unfortunate children are born with a myelomeningocele. This is an open defect in the back with elements of spinal cord visualized at the skin. Another group has more subtle physical findings on their back, including a dimple, birthmark, lipoma, hemangioma, or hairy patch. The condition may become apparent in some children only when they develop signs of spinal tethering, including difficulty going to the bathroom, leg pain or weakness, or orthopedic problems. A final group of children may be suspected of spinal tethering because of its association with other medical problems, such as vertebral, anal, tracheal or esophageal anomalies, or cardiac problems. Once the diagnosis is suspected, an MRI is usually recommended to confirm that the condition exists.

Treatment Options
It is well understood that in the majority of children with tethered cords neurological function will deteriorate with growth and activity. This is due to diminished blood supply to the nerve cells. Therefore, even if your child does not have any symptoms, surgery is often recommended to prevent future neurologic deterioration and complications. Your surgeon can discuss the specifics of treatment after reexamination of the child and review of the MRI scans. Many tethering lesions can be treated with low risk operation, with an excellent prognosis for your child's future development. Other cases are quite difficult and may require more surgery as the child ages.

At Penn State Children's Hospital, we are leaders in the diagnosis and treatment of tethered spinal cords. Our Neurosurgical team works closely with many other specialists, including pediatric urologists, orthopaedists, radiologists and neurologists, to provide the most comprehensive medical treatment possible. For patients with spinal bifida, we run a weekly Myelomeningocele Clinic which is attended by all of the necessary specialists needed for the comprehensive care of your child. State-of-the-art MRI scanning and detailed testing of bowel and bladder function lead to accurate diagnosis of the condition and its effect on your child. Our surgical procedures are highly refined, using operative microscopes, lasers, and nerve monitors to perform surgery safely and effectively. Penn State Children's Hospital has the resources to support you and your child throughout the entire process, with specialists dedicated to the diagnosis, treatment, and long-term of care of the child with a tethered spinal cord.