Tethered Cord

The filum terminale is a band of fibrous connective tissue that attaches the end of the spinal cord (conus medullaris) to the sacrum, normally after three months of age. When the filum is normal, the spinal cord floats freely within the dural sac. However, when the filum is abnormal (for example tight, thick and/or fatty), the spinal cord can become tethered. This is due to traction on the conus and stretching of the spinal cord, which causes injury. 

What’s in this section?

Signs and symptoms

Signs and symptoms of tethered cord depend on the age of the child. Symptoms in babies often include:

  • Delays in motor milestones, such as walking
  • Dark or red spots, patches of hair or soft masses on the back, typically around the mid-back
  • Spinal deformity
  • Differences in leg lengths
  • Foot deformities

Symptoms in older children often include:

  • Back and leg pain
  • Bowel problems such as constipation
  • Bladder problems such as not being able to potty train
  • Abnormal curvature of the spine
  • Leg weakness
  • Loss of sensation in the legs
  • Difficulty walking
  • Muscle wasting in the legs
  • Foot deformities
  • Numbness/tingling in the feet
  • Spasms/tremors in the legs
  • Spinal deformity
  • Differences in leg lengths

Diagnosis

Diagnosis of a tethered cord starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose this condition, including magnetic resonance imaging (MRI) and computed tomography (CT).

Treatment options

The different treatment options for a tethered cord depend on the severity of your child’s symptoms and can include:

  • Physical therapy
  • Tethered cord release surgery. Tethered cord release surgery is done to release the spinal cord in order to stabilize neurological function and prevent irreversible neurological injury. The release surgery involves making an incision in the midline of the lower back below the level of the conus, making a small bony opening called a laminotomy, opening the dura (a membrane that covers the spinal cord and nerve roots) and carefully separating the filum from the nerve roots. After this, the spinal cord is released and can float freely within the spinal canal. 
Conditions

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