Tethered Spinal Cord Syndrome is a neurological disorder
caused by tissue attachments that limit the movement of the Spinal
Cord within the Spinal Column. The course of
the disorder is progressive once symptoms are first
The term "Tethered Spinal Cord" refers to any condition
in which the Spinal Cord is attached to an immovable structure.
Normally the bottom of the Spinal Cord (called the Conus
Medullaris) floats freely within a pool of
Cerebrospinal Fluid. There are, however, several
pathologic conditions that cause this tethering. This
often leads to abnormal stretching of the Spinal Cord and its
nerve roots as the patient grows and with movement.
The causes of Tethered Spinal Cord are generally
regarded to be errors in the normal development of the fetus.
Many of these errors occur even before a woman knows that she is
pregnant. Folate (Folic Acid) supplements for women in child bearing
years can reduce the rate of some problems (such as open Spina
Bifida) but many causes of Tethered Spinal Cord are not affected
by Folic Acid.
Over time the "Tethering" can lead to the characteristic
symptoms of Tethered Spinal Cord, which are:
The primary "causes" of Tethered Spinal Cords include
conditions such as:
- Muscle weakness
- Sensory loss
- Change in bowel or bladder control
- Orthopedic deformity.
In children, symptoms may include observable surface lesions
such as hairy patches, dimples, or fatty tumors (Lipomas) on the
lower back; foot and spinal deformities; weakness in the legs; low
back pain; scoliosis; and incontinence.
- Dermal Sinus Tract
- Diastematomyelia (split Spinal Cord)
- Myelomeningocele ("Spina Bifida")
- "tight" Filum Terminale
- Past trauma
- Previous surgery on the Spine particularly for Myelomeningocoele repair
Tethered Spinal Cord Syndrome may go undiagnosed until
adulthood, when sensory and motor problems and loss of
bowel and bladder control emerge. This delayed
presentation of symptoms relates to the degree of
strain placed on the Spinal Cord over time. Tethered
Spinal Cord Syndrome is closely linked to Spina Bifida
and seems to occur as a result of improper growth of the neural
tube during fetal development.
Tethering may also develop after Spinal Cord injury and scar
tissue can block the flow of fluids around the Spinal Cord. Fluid
pressure may cause cysts to form in the Spinal Cord (a
This can lead to additional loss of movement, feeling or the onset of
pain or autonomic symptoms.
Spina Bifida may never cause any symptoms. In cases that
eventually become symptomatic (as the Tethered Spinal Cord Syndrome)
the onset of symptoms may not become apparent until adolescence or
later (including adulthood). In these instances, CT
and/or MRI Scans are helpful in establishing the diagnosis.
Occasionally Myelography and post-myelographic CT scans
are used to more definitively identify the critical
anatomical details of the anomaly (See Figure 1).
Figure 1: Post-myelographic CT Scan of Spina Bifida
This Lumbar Vertebra's Spinous Process
is "BIFID" (meaning "split in two") indicated by the
Double-headed Arrow. In this case the Spinal Cord is split
into 2 separate segments (Vertical Arrows).The "Cords" are
situated towards the Posterior aspect of the Spinal Canal.
The next lower CT Scan images demonstrate the "Tethering" of
the Cord by a Lipoma in the Filum Terminale. (See Figures
This represents a case that was not identified until later
life when as an adult the patient developed urinary
Figure 2: Post-myelographic CT Scan at the Sacral Level.
Tethered Spinal Cord & Filum Terminale Lipoma
The precise point of tethering of the
Spinal Cord, at the bottom of the Spinal Canal, is indicated
by the "dark" spot within the Spinal Canal (Arrow). The point
of tethering is identified by "indenting" of the "dye" (white
material) that was injected to mix with the CSF.
Note: Same patient as Figure 1, 3 & 4.
In children, early surgery is recommended in an effort to
prevent further neurological deterioration.
In adults, surgery to release the Tethered Spinal Cord and/or
reduce the size of Spinal Cord Cysts may abort the inevitable
progression of the symptoms, may restore some function or alleviate
other symptoms and stop further development of cysts within the
Spinal Cord. If direct surgical relief of the cause of the
tethering is not advisable, Spinal Nerve Roots may be cut to
A lumbar & Sacral Laminectomy has been
performed. The Dura Mater has been opened to expose the
Lipoma (which has been cut in two.) Note that the Spinal Nerve
Roots (Vertical Arrows) lie beside the Lipoma and extend
through the Dura to leave the Spinal Canal at their normal
This is a lower power magnification
view to demonstrate the distal Spinal (S1 & S2) Nerve Roots
(Vertical Arrows). The Lipoma of the Filum Terminale and its
attachment to the Dura Mater has been removed (Curved
Note: Compare to Figure 3 where the Lipoma is cut in two but
left in place for the moment.
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This page last edited on 2/19