tethered cord syndrome (tcs)

Tethered Cord Syndrome is a progressive neurological disorder caused by tissue attachments that do not allow the spinal cord to move correctly and limit the movement of the spinal cord in the spinal column. Due to its limited movement, it causes abnormal stretching of the spinal cord. Severity of symptoms can vary depending on when in life it is diagnosed. The longer it goes untreated, the more strain that is put on the spinal cord over time. Later in life, it has been known to cause sensory and motor problems as well as loss of bowel and bladder control. Tethered spinal cord syndrome is thought to be a neural tube defect, where there is improper growth of the neural tube during the development of the fetus, and is closely related to spina bifida. It may also be caused by a spinal cord injury. Syringomyelia may also develop as a result of scar tissue development if it blocks the normal flow of the cerebral spinal fluid, and a cyst is formed inside the spinal cord. If Syringomyelia develops, additional pain, loss of sensation and autonomic symptoms may occur.

Symptoms:

Urinary: urgency, frequency of urination, urinary incontinence, urinary retention, frequency of urination at night, Difficulty starting urinary stream, constipation, diarrhea, occasional incontinence for stools, decrease interest in sexual relations, difficulty reaching an orgasm, decreased sensation in your pelvic area, low back pain, leg pain, numbness under the soles of your feet, keeping your knees bent at night, low back pain, leg pain, or urinary symptoms while walking up stairs, history of severe growing pains during childhood and adolescence.

Treatment:

 In children, early surgery is recommended to prevent further neurological deterioration. Untethering is generally performed only if there are clinical signs or symptoms of deterioration. The surgery involves opening the scar from the prior closure down to the covering (dura) over the myelomeningocele. Sometimes a small portion of the bony vertebrae (the laminae) are removed to obtain better exposure or to decompress the spinal cord. The dura is then opened, and the spinal cord and myelomeningocele are gently dissected away from the scarred attachments to the surrounding dura. Once the myelomeningocele is freed from all its scarred attachments, the dura and the wound are closed. Other treatment is symptomatic and supportive.

The length of time for the actual operation is approximately 4 to 6 hours, but it can vary depending on how much tethering has occurred. The usual hospital length of stay is 4 to 5 days.