Tethered Spinal Cord

 A tethered spinal cord is a spinal cord that is tied down or ‘tethered’ to tissues at the bottom end of the spinal column, preventing the spinal cord from moving freely. Before birth, a baby’s spinal cord and spinal column (vertebrae surrounding the spinal cord) are roughly the same length. As the baby grows, the spinal column gets longer than the spinal cord, allowing the latter to move freely inside the column of vertebrae. In babies with tethered cords, this free movement of the spinal cord is not possible because the tail-end of the spinal cord is attached to the tissues around the spine. As the child grows, the spinal cord is stretched, which causes problems with nerve function as the nerves also get stretched with the spinal cord.  

A tethered cord can occur due to congenital abnormalities, such as spina bifida (incomplete closure of spinal cord at birth), or due to the development of abnormal fibrous tissue to which the spinal cord may get tethered. Other factors may include tumours, infection of the spinal cord, trauma to the spine, growth of a fatty piece of skin into the spine (dermoid or epidermoid) or a complication of spinal surgery.

It occurs more commonly in children, and is less frequently observed in adults and adolescents. 

Symptoms of tethered cord progress over time as the child grows older. Some of the signs and symptoms your child will experience or reports to you include:

  • Problems controlling bladder or bowel movements

  • Pain and weakness in the legs or feet

  • Pain in the back, which worsens with activity

  • Scoliosis – abnormal curvature of the spine

  • Fatty tumour or deep dimple on the lower back

  • Numbness and tingling in the back

  • Deterioration in gait

  • Muscle contractions

  • Tenderness in the spine​​

If left untreated, tethered cord can also cause nerve damage which may be irreversible. Early diagnosis and treatment is important for ensuring the maximum possible recovery for your child. If you notice the signs and symptoms of tethered cord in your child, discuss this with a paediatric neurologist working with the Mind and Brain Service Line​ of The Aga Khan University Hospital.​​​
Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here​ are some tips to help get you started.​

Your child’s doctor will ask you detailed questions about his/ her symptoms as part of diagnosing a tethered cord. These questions will be about his/ her symptoms, their specific characteristics, and how they have progressed. Thereafter, a physical examination will be conducted in which your child’s doctor will feel the lower back for any tender spots and ask him/ her to change position to see how pain is affected by movement. 

Ultrasounds in newborn babies less than three months of age can also be used for diagnosis as their bones have not thickened yet. This will show details of the end of the spinal cord and also if a tethering obstruction may be holding the cord taut. It can also help identify any tumours or fatty masses at the end of the spinal cord.

Other diagnostic tests for older children include:

  • Magnetic Resonance Imaging (MRI) – helps generate three-dimensional images of the spinal canal and its structures

  • X-rays to detect abnormalities in the bone structure

  • Computed Tomography (CT) scans of the lower back – gives detailed information about an abnormality in the child's spine

  • Myleogram – it’s like an X-ray of the spinal canal with the help of a contrast material. It helps show pressure on the spinal cord or nerves due to a tethered spinal cord

  • Urodynamics testing and urology consultation — since the nerves at the bottom of the spinal cord control bladder function, your child may have problems with bladder control, which can be identified through these tests and consultation with a urologist​

Tethered cord is a very treatable condition, especially when diagnosed and treated early in the child's life. Generally neurologists recommend early surgery to treat this condition in a growing child to prevent chances of deterioration of nerve function later in life. 

The scope and extent of surgery will depend on your child’s overall health and well-being, as well as the cause and location of the tethering. Either the tissue scar, the tumour or mass causing the tethering is or, at times, a tiny portion of the vertebrae will be removed to allow the spinal cord to move freely. 

Before or after surgery, your child may also be recommended the following as part of the treatment plan:

  • Pain-relieving medications for management of pain

  • Physical and occupational therapy to build muscle strength and improve motor skills​

Please click here​ for some guidelines on “what to do before your surgery”.​
​Please click here​ for some guidelines on “what to do on the day of your surgery”.​

Possible complications in surgery for untethering the spinal cord will depend on the complexity of the problem. In some cases, a minor incision may suffice. On others, a more involved procedure may be required, such as in the case of a fatty mass or tumour causing the tethered cord. In case of a fatty mass or tumour enveloping sensitive nerve roots responsible for strength and sensations in the legs, bowel or bladder, the risks may be higher. 

Post-surgery, recovery of muscle and bladder function will also depend upon the condition of your child’s tethered cord prior to surgery. Complications such as infection, bleeding, damage to the spinal cord, or nerves responsible for bladder or bowel function are possible. In many cases, repeat surgery may be required as the child grows further.

You must make sure that you discuss your child’s individual case and all these possible complications in detail with the neurologist. Weigh the risks of surgery against the benefit of helping your child lead a normal, active life to make an informed decision before going ahead with treatment. ​

Please click here​ for some guidelines on “what to do after your surgery”​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.​

​Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.​

The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the ​advice of your doctor or other healthcare professional provider. ​