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Tethered Spinal Cord | Overview

What is a tethered spinal cord?

A tethered spinal cord occurs when the spinal cord is attached to tissue around the spine, most commonly at the base of the spine. As a result, the spinal cord can’t move freely within the spinal canal. This can cause the spinal cord to stretch out as the spine grows, leading to possible nerve damage, pain and other symptoms. In most cases, the condition becomes worse over time.

Tethered spinal cord is common in children with spina bifida, but it also occurs in children who don’t have this condition.

The good news is that tethered spinal cord is a very treatable condition, especially when diagnosed and treated early. Surgery is the most common treatment to “untether” the spinal cord from the spinal tissue.

 

Mark Proctor, MD - Neurosurgeon-in-Chief, Department of Neurosurgery

How we care for tethered spinal cord

Our team at the Boston Children’s Hospital Tethered Spinal Cord Program provides complete diagnostic, consultation, surgical and follow-up care for children with tethered spinal cord.

Tethered Spinal Cord | Symptoms & Causes

What causes tethered spinal cord?

In many cases, children are born with a tethered cord because of a problem during the development of the spine. Tethered spinal cord can also occur after birth due to damage to the spine or from scar tissue after surgery.

What are the symptoms of tethered spinal cord?

The symptoms of tethered spinal cord can vary depending on the age of your child. Some people may not have any symptoms until they are adults, although this is rare.

Symptoms in newborns include:

  • an unusual dimple, raised bump, discoloration or patch of hair on the lower back
  • unusual anatomy of the genitals 
  • unusual anatomy of the anus
  • one leg or foot that is longer or larger than the other 

Symptoms in infants and older children include:

  • pain in the lower back
  • weakness or numbness in the legs or feet
  • problems standing or walking
  • loss of bladder or bowel control

Tethered Spinal Cord | Testing & Diagnosis

How is tethered spinal cord diagnosed?

The tests your child’s doctor will use to diagnose tethered spinal cord may depend on your child’s age.

  • For newborns younger than 3 months, the easiest and fastest way to diagnose this condition is with an ultrasound of the back. An ultrasound uses high-frequency sound waves to take pictures the spinal canal. 
  • For children older than 3 months, the most effective test is magnetic resonance imaging (MRI). An MRI uses a combination of powerful magnets, radiofrequency waves and special computers to create three-dimensional images of the spine. 

Other tests your child may need

Depending on your child's symptoms, the doctor may also recommend other tests:

  • X-rays use small doses of radiation to take pictures of parts of the body. For tethered cord, x-rays are used only in special situations, such as to see unusual changes in bone structure.
  • Computed tomography (CT) scans use a combination of x-rays and powerful computers. Sometimes CT scans are used to see more detail of an abnormality in the spine. 
  • Urodynamics testing measures how well the nerves from the spinal cord to the bladder are working. Many children with tethered cord have problems with bladder control. These tests can confirm nerve damage caused by tethered cord and help clinicians plan surgery.

Tethered Spinal Cord | Treatments

What are the treatment options for tethered spinal cord? 

For many children, surgery to “untether” the spinal cord is the only treatment for tethered spinal cord. There are several types of surgery, depending on the cause of the tethering and how much tissue is affected.

  • Surgery for a thick or fatty filum terminale (the tissue that connects the spinal cord to the backbone) - When the tethering is caused by a thick or fatty filum terminale, the surgery is relatively quick and simple. Most children who have this type of surgery are in the hospital for two to three days. 
  • Surgery for tumors or fatty masses – This type of surgery is usually more involved because the tissue tethering the spine may have grown into the spine and nerves around it. Children who have this type of surgery usually stay in the hospital for four to seven days.

Your neurosurgeon can provide you and your family with the most specific and detailed recommendations for your child's surgical treatment.

Can medication help?

Tethered spinal cord can't be treated with medication, but it can help manage the some symptoms of tethered spinal cord. Your child’s doctor may prescribe:

  • analgesics to relieve pain
  • muscle relaxants to prevent painful muscle spasms 

Follow-up care after surgery

The type of follow-up care your child will need depends on his or her surgery and the extent of the tethering. In most cases the neurosurgeon will follow your child’s progress with yearly exams to make sure the spinal cord does not become tethered again.

Support services

If your child had any nerve damage before surgery, he or she may continue to have problems with bladder or bowel control, pain or weakness in the legs or feet, or trouble standing and walking. Children with these problems may benefit from support services such as physical therapy or occupational therapy.

Expert care for tethered spinal cord

Our experts in the Boston Children's Hospital Tethered Spinal Cord Program have years of experience treating these disorders, using minimally- invasive techniques whenever possible. We’re always available to answer questions and address any concerns you may have.

Helpful links

You can learn more about tethered spinal cord on the following websites:

Tethered Spinal Cord | Programs & Services