Tethered Cord Syndrome

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Tethered cord syndrome

Tethered cord syndrome, lipomeningomyelocele, or meningomyelocele, includes a group of congenital diseases,( which child is born with) may include swelling in the midline of the lower back of the spine, filled with CSF ( brain water and nerves), or this may be containing fat entangling the nerves meant to supply the lower limbs.

It may include tethered cord syndrome, in which a fibrous structure called “filum terminale” which is tightly stretched to the lowest part of the spine. In normal cases, the cord normally ends at L1 levels in the majority of these children; it is associated with the low ending of the cord up to L3, L4, or even lower. When the child grows there is a development of symptoms as a result of fixation and excess strain on the spinal cord caused by stretching.

This is a complicated syndrome may be associated with hydrocephalus, or descent of a part of the brain in the spinal cord called Arnold chair malformation. Other conditions associated are syringomyelia, which means water in the spinal cord, the exact cause of which is not known but often is associated with this syndrome complex.

Other associated conditions that can be found on physical examination include cutaneous/subcutaneous stigmata, scoliosis, or foot deformities.

If lumbar meningocele ( swelling) is ruptured at birth or early on birth it has a potential risk of infection and is an emergency that should be offered surgery as soon as possible.

Common Symptoms Include  

  • The pain usually in legs progressive as child gains height
  • Weakness or even paralysis in lower limbs
  • Sensory deficits
  • Bladder dysfunction
  • Bowel dysfunction

These symptoms can potentially be halted from further worsening or reversed after surgical excision of swelling, microscopic dissection of nerves, and detethering.

Magnetic resonance imaging (MRI) is the imaging modality of choice diagnosis. Another important step in the diagnosis of this condition is the history and physical examination.

TCS comprises a set of symptoms that result in increased tension and aberrant strain on the spinal cord. This strain leads to nerve dysfunction, with symptoms relating to the strained nerve fibers. The longer and more severe the impairment, the worse the outcome is for the patient.

The signs and symptoms include pain, weakness, paresthesia, dysesthesia, bowel dysfunction, and bladder dysfunction and they have the potential to deteriorate over time.

 Tethered cord is found in two age groups 

  1.  type 1 has symptoms initially present in adulthood
  2.  type 2 has symptoms present in childhood with progression in adulthood

This progression is triggered from external factors such as sudden flexion or extension of the spine, sports especially gymnasts, swimmers, blunt trauma to the spine, excessive physical training, direct spinal injury, child delivery in the lithotomy position, and degenerative disease MRI is suggested when the filum terminale width is >2 mm, the CONUS terminates below L1/2, and/or there is a posterior displacement of the conus medullaris and filum terminale. A wide sacral subarachnoid space can also be seen.

If the cause of TCS is solely a thickened filum terminale, then, sectioning of the filum terminale usually provides an adequate release.

In our center, we perform this surgery under intraoperative neural monitoring, under an operative microscope to ensure no normal structure or even nerve fiber which at times is as thin as a hair strand is damaged.

The goal of surgery is the resolution of symptoms, which often is not possible because of delay in seeking attention, a previous myelomeningocele repair, the operation can be more complex because of the aberrant anatomy. Dural closure, either with native dura or duraplasty, is a key step to preventing cerebrospinal fluid leakage.

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Spine and Brain Healers provides advanced medical care in the field of Adult neurosurgery,Paediatric Neurosurgery surgery, and Interventional Neurosurgery .

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Copyright 2020 by Brandingpioneers. All rights reserved.