Tethered cord

Dr Derek Smith and Radswiki et al.

Tethered spinal cord syndrome, also known as an occult spinal dysraphism sequence, is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column.

The condition is closely linked to spina bifida, and as such presentation in childhood may be with the cutaneous stigmata of dysraphism (hairy patch, dimple, subcutaneous lipoma).

There may be associated foot and spinal deformities, leg weakness, low back pain, scoliosis and incontinence.

The condition may go undiagnosed until adulthood, with the development of sensory and motor problems and loss of bowel and bladder control.

Spinal cord tethering should be thought of as primary and secondary:

  • primary tethered cord syndrome occurs as an isolated anomaly
  • secondary tethered cord syndrome occurs in the setting of other abnormalities, e.g. myelomeningocelefilum terminale lipoma, trauma 3

The spinal column develops at a greater rate than the spinal cord during fetal development, and abnormal attachments lead to abnormal stretching of the spinal cord.

Tethering may also develop after spinal cord injury and scar tissue can block the flow of fluids around the spinal cord.

Fluid pressure may cause cysts to form a syringomyelia

Imaging features are of a low conus medullaris (below L2) and thickened filum terminale (>2 mm).

Ultrasound may be a useful screening exam and may be of use in the pediatric population. The lack of ossification of the posterior arch of the spine in normal infants and the presence of a bony defect in patients with spina bifida permit sonographic examination.

MRI is useful in visualizing the conus medullaris, assessing the thickness of the filum terminale, identifying traction lesions, and evaluating associated bony dysraphisms.

In one study of 25 patients in 84% the tip of the conus was below the level of the mid-L2 vertebral body 1.

Prone imaging may be useful in patients who have undergone tethered cord surgery or in those in whom clinical suspicion is high while supine MRI imaging demonstrated no abnormalities. Prone MRI imaging is however of little value when supine MRI has demonstrated the defect.

Untreated, tethered cord syndrome has a progressive course. Surgical release, in selected patients, can dramatically improve function 3

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Article information

rID: 13494
Tag: spine
Synonyms or Alternate Spellings:
  • Spinal cord tethering
  • Tethering of spinal cord
  • Tethered cord syndrome
  • Occult spinal dysraphism sequence
  • Tethering of cord

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Cases and figures

  • Case 1: with diastematomyelia
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  • Case 2: with lipomyelomeningocoele
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  • Case 3: with vertebral and spinal cord malformations
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  • Case 4: on ultrasound
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  • Case 5: tethered cord entering meningocele sac
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  • Case 6
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  • Case 7: cord ending at the level of L3
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  • Case 8
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  • Case 9
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  • Case 10: with filum terminale lipoma
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