The lower end of the spinal cord floats in fluid within the bones at the end of the spine, attached to the tailbone by a thin elastic thread of tissue. In some children, developmental abnormalities cause fixation of the end of the spinal cord to other structures, a condition known as a tethered spinal cord. Fixation of the spinal cord puts tension on the nerves, potentially leading to permanent damage as the child grows. Surgery is the primary form of treatment for patients with a tethered spinal cord.
Spinal Cord Release Surgery
Several types of developmental abnormalities can lead to a tethered spinal cord, including a variety of malformations of the spinal bones, nerves and covering membranes. Congenital tumors in the lower end of the spine can also cause spinal cord tethering, reports the Columbia University Medical Center Department of Neurosurgery. For patients with a tethered spinal cord and symptoms indicating nerve tension or damage, doctors usually recommend a spinal cord release operation.
Spinal cord release procedures involve opening the lower back to gain access to the site of tethering. The specifics of the release operation vary, depending on the cause of the tethering and the degree of entanglement of the spinal nerves at the site of fixation. Some spinal cord release surgeries prove relatively simple in the hands of a skilled neurosurgical team, while others can be exceptionally complex.
Surgical Pain Control
Preserving spinal cord function is the primary objective of neurologists and neurosurgeons treating patients with a symptomatic tethered spinal cord. For this reason, surgical release of the cord remains the treatment of choice for most patients. In some cases, however, an open spinal cord release cannot be accomplished. In these circumstances, doctors may recommend severing, or cutting, some of the spinal nerves if tension on the cord causes significant pain, explains New York-Presbyterian Hospital.
Watchful Waiting
A tethered spinal cord usually presents in childhood. As the child grows, increasing tension on the fixed spinal cord usually causes symptoms, including back or leg pain, leg weakness or loss of sensation, curvature of the spine and loss of bladder or bowel control, reports the Lucile Packard Children's Hospital at Stanford University. Some patients, however, reach adult height without developing symptoms of spinal nerve damage. In these patients, doctors may recommend close monitoring for symptoms of nerve damage rather than surgery. This management strategy, known as watchful waiting, avoids surgery that may not prove immediately necessary while maintaining active monitoring to detect problems that may require later surgical intervention.
References
- Columbia University Medical Center Department of Neurosurgery: Tethered Spinal Cord
- New York-Presbyterian Hospital: Tethered Spinal Cord
- Lucile Packard Children's Hospital at Stanford: Tethered Cord Syndrome
- American Association of Neurological Surgeons: Tethered Spinal Cord Syndrome
- Childhood Neurosurgery and Center for Hydrocephalus: Congenital Spinal Abnormalities, Spina Bifida and Chiari Malformations
