Tethered Cord syndrome is characterized by a spinal cord that is located at an abnormally low position within the spinal canal. By adulthood, the tail end of the spinal cord typically comes to rest near the L1 or L2 levels.  Tethered cord syndrome results when the spinal cord is placed under abnormal tension (pulling force) and cannot ascend to the normal level.   The abnormal stretching of spinal cord results in damages to the spinal cord and nerves.

Most patients with tethered cord syndrome present in their childhood or adolescence.  Various causes can be responsible for tethered cord syndrome.  Common causes of tethered cord are often related to developmental abnormalities, including Spina Bifida, Thickened Filum Terminale, and Lipomas.  Children typically experience difficulty with walking or bladder and bowel dysfunctions.  On the other hand, adults often have pain or weakness in their legs or back, sensory disturbances, and urinary problems that are often aggravated by trauma, spinal stenosis, disc herniation, and stretching of the spine.  In addition, abnormal foot arches can be seen.

Diagnosis:

Diagnosis of tethered cord is made by clinical history and an MRI of the lumbar spine.  On MRI, a low lying spinal cord can be seen below the level of L2.  Other findings include a thickened filum terminale, spina bifida, or lipoma (fatty tissue) in the tail end of the spinal cord.

Treatment:

Treatment of tethered cord is directed at the cause of the problem.  Patients with thickened filum terminale will require division of the filum to release the spinal cord tension.  Those with spina bifida or lipoma will require releasing of the spinal cord away from the scar tissues from the soft tissues and skin.  Often times, patients with tethered cord symptoms will have re-tethering of the spinal cord from surgical scarring, and they require multiple untethering procedures.  However, each repeated procedure is performed with increasing risk to nerves and spinal cord and the chance of improvement is diminished with multiple surgeries.  The USC Neurosurgery Spine Center now offers a cutting-edge procedure to treat patients with recurrent tethered cord syndrome.  The procedure involves shortening of the spine to reduce the abnormal tension on the spinal cord and nerve root.  Dr. Hsieh the leading author on one of two scientific papers on this procedure and this procedure is only offered in a small number of spine centers around the world.  Early results of this procedure are favorable with decreased risks of nerves and spinal cord injury and spinal fluid leak as seen in traditional untethering surgery.

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