What is a tethered cord?

The normal spinal cord begins at the junction of the base of the skull and the uppermost portion of the spine called the cervical spine. The spinal cord extends through the center of the spinal column from the neck to just below the junction of the thoracic-lumbar (mid-back) area. At this point, a normal spinal cord is able to move freely within the spinal column when a child bends or moves.

Tethered cords are a group of congenital developmental malformations in which the spinal cord is fixed to surrounding tissues within the spinal column and cannot move freely at the lower end. As a child grows, his or her spinal column grows, but the spinal cord may not grow at the same rate. This fixation of the spinal cord as the spine lengthens causes tension on the spinal cord and nerves, producing various symptoms.

What are the causes of tethered cord?

• Spina bifida—the most common cause
• Lipoma—a fat mass under the skin connected to the spinal cord
• Split cord malformation—a double spinal cord or tract dividing the cord into halves
• Dermal sinus tract

What are the signs and symptoms of a tethered cord?
The signs and symptoms vary from patient to patient and occur most often during a child’s growth spurts. The most common signs and symptoms are:

• Pain in the lower back
• Pain in the leg or feet
• Weakness of the muscles of the legs and feet
• Sensory loss in the genital area or feet
• Loss of or change in bladder and/or bowel control; some children never develop good bowel and bladder control
• New onset or worsening of scoliosis, or curvature of the spine
• Skin markers of the lower back—tuft of dark hair, port wine–colored birth mark, deep dimple in the back, doming of the skin due to underlying fatty tissues

Which scan and test are important in the diagnosis of a tethered cord?
A magnetic resonance imaging (MRI) provides the best diagnostic images of a tethered cord along with a neurological history and exam. If there is a history of loss of or change in bladder control, a referral to a pediatric urologist should be done to evaluate your child’s bladder’s ability to empty completely or reflex urine back into the kidneys.

What is the treatment for a tethered cord?
Surgery to untether the cord is the only effective treatment. The goal of the surgery is to prevent further neurological symptoms and to try to regain or improve function that is already lost.

The surgery for a tethered cord may last about four to six hours and is performed under general anesthesia. Once your child is asleep under anesthesia and positioned on the abdomen on the surgery table, the neurosurgeon usually makes a vertical incision over the area of the spine that is tethered. The muscles are retracted back to expose the spinal cord. Once the spine or vertebrae are exposed, the neurosurgeon performs a laminectomy to expose the dura and spinal canal. A laminectomy is the removal of the bony coverings of the back portion of the spinal canal. The dura, which covers the spinal cord and nerves, is opened to expose the tethered area of the cord. The spinal cord is then freed from the surrounding tissues. After the cord is freed, the dura is then closed and the skin is sutured closed.

What will happen after surgery?
When surgery is completed, your child will go to the recovery unit. After the nurses assess your child and connect him or her to a monitor to observe vital signs, one parent will be allowed to stay in the recovery room until transfer to the pediatric unit.

Your child will be kept on flat bedrest for the first 24-48 hours to prevent a cerebral spinal fluid leak and spinal headaches. A Foley catheter will drain your child’s urine while he or she is on flat bedrest. Gradually, your child’s diet and activity will be advanced.

Your child’s pain management will be individualized and discussed with you by the neurosurgeon or the nurse.

*Note: This information is intended to be used in consultation with your health care provider. It does not replace specific instructions, directions or warnings given to you by your child’s physician.