Tethered cord syndrome is a neurological condition in which the spinal cord is abnormally attached to surrounding tissues, restricting its movement within the spinal canal. This abnormal attachment can cause stretching of the spinal cord as the child grows, leading to neurological symptoms. Common signs include back pain, leg weakness, sensory deficits, bladder or bowel dysfunction, and gait disturbances. The condition can be congenital, often associated with spina bifida or other spinal anomalies, or acquired after trauma or surgery. Early detection is crucial to prevent irreversible nerve damage. Pediatric and adult neurosurgeons focus on careful evaluation and timely surgical intervention to release the tethering, preserve neurological function, and prevent progression of symptoms.
Diagnosis involves a detailed neurological examination, assessment of motor and sensory functions, and evaluation of bladder and bowel control. MRI of the spine is the gold standard for visualizing tethered cord, fatty filum, or associated spinal anomalies. Ultrasound may be used in infants. Additional studies, such as urodynamic tests, help evaluate bladder involvement. Accurate diagnosis is essential to determine the appropriate timing and method of surgical intervention, minimizing risk to the spinal cord and optimizing outcomes.
Surgical untethering is the primary treatment for tethered cord syndrome. The procedure involves carefully releasing the spinal cord from abnormal attachments while protecting nerve roots and surrounding structures. In select cases, minimally invasive or endoscope-assisted techniques may be employed to reduce tissue trauma and enhance recovery. The goal of surgery is to relieve tension on the spinal cord, halt neurological deterioration, and improve motor, sensory, and bladder function. Timing of surgery is individualized based on symptoms and imaging findings.
Postoperative recovery involves careful neurological monitoring, pain management, and gradual mobilization. Rehabilitation may include physiotherapy to strengthen lower limb muscles, gait training, and occupational therapy to improve daily function. Bladder and bowel training may be necessary if preoperative deficits existed. Follow-up imaging ensures complete untethering and monitors for retethering or recurrence. With structured care, most patients experience symptom improvement, preserved neurological function, and enhanced quality of life.
Dr. Vamsi Krishna, Consultant Neurosurgeon at Yashoda Hospitals, Hitech City, Hyderabad, specializes in pediatric and adult spinal disorders. His expertise in microsurgical and minimally invasive untethering techniques ensures safe, precise release of the spinal cord, optimal functional outcomes, and long-term neurological protection, making him a trusted expert in tethered cord management.
