Tethered Cord Syndrome

This disorder is caused when a thickened filum terminale limits the movement of, or "tethers" the spinal cord within the spinal column. The filum terminale or “terminal thread” is a normal structure that stabilizes the spinal cord within the spinal canal but has no real neurological function. Over time the tethered spinal cord is repeatedly stretched whenever the patient bends at the waist or flexes their neck. The repeated stretching of the spinal cord eventually causes symptoms such as bladder incontinence, leg pain and numbness, balance disturbance and weakness of the legs. 

The tethering may affect the function of the entire spinal cord even though the structural problem lies at its lowest point. As a result, those affected by tethered cord syndrome may complain of headache, nausea and even arm pain.

Tethered spinal cord is frequently diagnosed in children, usually in conjunction with spina bifida. An adult tethered cord syndrome has also been described. This is not associated with spina bifida but may occur in patients with the Chiari 1 malformation. Some doctors believe that spinal cord tethering may be one of the causes of Chiari  1 malformation.

Testing and Diagnosis

 

Treatment

Surgery is the only treatment for tethered cord. In the case of adult tethered cord not associated with spina bifida, the surgery simply involves removing a small amount of bone at the base of the spine – S1 laminectomy- and sectioning of the filum terminal. Keep in mind that the filum terminale is not a nerve and can be cut without causing any harm. Treatment of tethered cord in conjunction with spinal bifida is much more complicted. The surgery actually varies with the type of spinal bifida.

View Tethered Cord Surgery Image
Please note: the following image is of a graphic nature.

  • The Tethered Cord surgery image can be viewed by clicking here.

View Tethered Spinal Cord Video
Please note: the following video clip is of a graphic nature.

  • Video This video demonstrates an Intra-operative view showing the sectioning of the filum terminale in the case of tethered spinal cord. Note the brisk retraction of the filum once it has been cut indicating that it had been under tension.
 

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