Tethered Cord

Tethered Cord is a rare neurological disorder where the spinal cord is unable to move about normally due to tissue attachments. These attachment cause abnormal stretching of the spinal cord. This stretching interferes with the nerves functions in the spinal cord and causes the symptoms which may include problems with sensations, movement and bodily functions.

Tethered cord syndrome seems to be the result of improper growth or the neural tube during fetal development. It is closely linked to other neural tube defects like spina bifida. It can also develop after spinal cord injury. 

Another variation of tethered cord that is more common in those suffering from Chiari and Ehlers Danlos is Occult Tight Filum Terminale Syndrome, this is where the filum terminale which joins the spinal cord to the backbone thicken or hardens causes a downwards pressure on the spinal cord. There has been some thoughts that this could scoliosis and Chiari Malformation. It is felt the downwards displacement pulls the cerebellum down causing Chiari Malformation, also that the hardening of the filum terminale is caused by Ehlers Danlos affect on connective tissue. However research into this is still very new and yet to be proven.  

Scar tissue from the two types can block the flow of fluids causing the pressure to build up resulting in syringomyelia. 

Signs and Symptoms

In children signs like hair patches, lesions, dimples and fatty tumours on the lower back are a sign of tethered cord. Other symptoms like deformities, back pain, scoliosis and incontinence can be seen. It is often undiagnosed until adulthood where growth spurts stretch the spinal cord and symptoms like sensory and motor problems occur. 

In adults severe lower back pain, weakness in muscles, bladder and/or bowel issues. Loss of pain, temperature and proprioceptive sensations are common issues. Urinary issues occur in a high percentage of patients. 

Treatment

Surgery is usually recommended as neurological deficits are generally irreversible. This can help prevent further neurological deterioration and help with  alleviation of symptoms and function. Surgery is used to release the filum terminale, other treatments are mainly used to help against symptoms and support the patient.

Prognosis 

This is generally progressive as people age, however with treatment patients have a normal normal life expectancy. Neurological impairments and other motor function symptoms are generally irreversible.