What is Tethered cord syndrome?
The tethered cord syndrome is a known neurological disorder that affects the spinal cord. As a result to this syndrome, there shall be restriction to movements. Usually, the condition affects the child after birth.
There is a congenital defect that makes the spinal cord abnormally attached to the tissues surrounding the base of the spine. The condition is also considered progressive, making the child’s life hard to cope with when no action is taken. When the condition was first discussed, years ago, it was fairly described as a fatty tumor in the sacrum connected to the spinal membranes.
Tethered Cord Syndrome MRI Scan Showing the Attachment of the Base of the Spine to the Surrounding Tissues
Those affected with tethered cord syndrome are noted to manifest the following:
- The back of the child has a fatty mass and hairy patch. The patches or tuft of fair is called hypertrichosis. Skin dimpling is also noted.
- As the lower part of the spinal cord is affected, the child is expected to manifest problems with the bowel and bladder control. There shall be difficulty in the bowel control. Incomplete bladder emptying is manifested. The child is prone to suffer from urinary tract infections. As the infant enters toddlerhood, parents will have a hard time potty training them.
- The child would persistently complain of back pain. There is an increased possibility of developing scoliosis. Sensory response is diminished in the legs and feet of the child. Manner of walking is also altered. The child is easily weakened after a walk and is most prominent when one is ambulating.
- Skin abnormalities are noted among cases of tethered cord syndrome. It has been reported that about 80 percent of those affected with tethered cored syndrome have this problem. The adults however shall manifest less skin abnormalities compared to those who are in their childhood.
- The child may also develop leg deformities. The affectation of the limbs is likely, especially the lower extremities.
The condition is considered as a congenital anomaly which affects the spinal cord. The tethered spinal cord is developed by the following ways:
- A child with spina bifida is at most risk for developing tethered cord syndrome. Spina bifida is known as a spinal condition that resulted from an opening of the spine. When the child has an underlying spinal cord injury or anomaly, tethered spinal cord syndrome is a great possibility to develop.
- Another form of spinal cord defect, spina bifida occulta, shall result to tethered cord syndrome.
- Derma sinus tract and diastematomyelia are congenital abnormalities that can cause tethered cord syndrome.
- An underlying lipoma, which is a benign growth, is another precipitating factor for tethered cord syndrome.
- A traumatic event that has greatly affected the spinal column can result or cause tethered cord syndrome.
The tethered cord syndrome can be diagnosed through the following tests:
- Imaging tests. An MRI may be ordered in order to visualize any form of abnormality in the spinal cord area. The nerve roots can also be assessed during this test. Identification of any form of enlargement in the spinal cord can be done. Another imaging test is the CAT scan. This test can generate images with the help or use of a special dye. An ultrasound is also helpful in the process of diagnosing the condition. Myelogram is a diagnostic examination that involves the use of an x-ray and by viewing the spinal cord and nerves with the introduction of a contrast dye in the thecal sac.
- Urodynamic testing. This test is performed in order to determine the child’s bladder function. There shall be collection of the client’s medical history and presenting symptoms.
Treatment & Surgery
The treatment for tethered cord syndrome is aimed in relieving the manifestations. The following are the proposed remedies for tethered cord syndrome:
The untethering of the cord is the most ideal treatment for tethered cord syndrome. It is only suggested or recommended whenever the presenting symptoms of the child are unbearable and that signs of deterioration are noted. The said intervention is to open a small portion of the lower back where the affected part is located. Dissection of the tissue attachments is performed to release the congenital anomaly. Then the incision shall be stitched back. After surgery, the child is placed in a supine position so that leakage of spinal fluid would be avoided. Recovery period shall take time as some degree of the normal function of the muscle and bladder control shall be attained.
Maintaining the client away from infections is a must. Close watch for infection should be rendered as the patient is at risk of acquiring it. Bleeding tendencies should also be watched out. After the surgery, the child is required to be admitted for 5 days max in order to monitor the state of the client. Pain relief is attained with the use of intravenous analgesics or pain relievers.
The condition presents a good prognosis, most especially when the syndrome has been treated in an early time as possible. Early detection with compliance to the treatment regimen can result to good prognosis. More chance of recovery is attained when the child undergoes surgery.
Tethered Cord Syndrome Pictures
Tethered Cord Syndrome Showing Discoloration at the Back
Tethered Cord Syndrome with Hairy Patch on the Level of Deformity at the Back