Tethered Cord Syndrome
Tethered cord syndrome is a condition where the lower end of the spinal cord is positioned lower than normal or abnormal attached tissues stretch the spinal cord. Normally, the lower end of the spinal cord (conus medullaris) terminates at the L1-L2 level in adults. In tethered cord syndrome, the spinal cord terminates lower (at L3 or below) or the filum terminale is thickened.
What Is Tethered Cord Syndrome?
Causes
Primary (Congenital) Causes
- Spina bifida occulta: Hidden spinal cleft
- Lipomyelomeningocele: Fatty tissue spinal dysraphism
- Dermal sinus: Connection between skin and spinal canal
- Thick filum terminale: Greater than 2 mm
- Diastematomyelia: Spinal cord splitting into two
Secondary Causes
- Adhesions after myelomeningocele repair
- Spinal trauma
- After spinal tumor surgery
- Spinal infection
Symptoms
In Children
- Skin findings in lumbar area (hair tuft, dimple, mass)
- Foot deformities (pes cavus, clubfoot)
- Leg asymmetry
- Frequent falls, walking difficulty
- Delayed toilet training
- Urinary incontinence (enuresis)
- Scoliosis
In Adults
- Low back and leg pain: Worsening with forward bending
- Numbness and weakness: In legs and feet
- Bladder dysfunction: Frequent urination, incontinence
- Bowel problems: Constipation
- Sexual dysfunction
- Scoliosis: Progression in adulthood
Diagnosis
- Spinal MRI: Conus level, filum thickness, lipoma presence
- Urodynamic study: Bladder function evaluation
- EMG: Nerve function assessment
- Neurological examination: Motor, sensory, and reflex evaluation
Treatment
Surgical Treatment
Prophylactic surgery for symptomatic patients or asymptomatic children:
Spinal Cord Untethering
- Approach through laminotomy or laminectomy
- Filum terminale section
- Lipoma excision (in lipomyelomeningocele)
- Releasing adhesions
- Use of intraoperative neuromonitoring
Post-Operative Care
- Hospital stay: 3-5 days
- Flat bed rest: 24-48 hours due to CSF leak risk
- Return to activities: 4-6 weeks
- Physical therapy: For selected patients
Prognosis
Neurological deterioration can be prevented with early surgery. Pain usually improves. Bladder function improvement is variable. Re-tethering (5-10%) may develop after surgery.
When to Operate?
- In children: As soon as diagnosed (to prevent neurological loss)
- In adults: When symptoms are present or progressing
Why Choose Prof. Dr. Salim Şentürk?
Prof. Dr. Salim Şentürk has experience in pediatric and adult tethered cord syndrome treatment. He performs safe untethering surgery with microsurgical techniques and intraoperative monitoring.
Does Your Child Have Back Skin Findings?
Schedule an MRI and examination for early evaluation.
Frequently Asked Questions
Is tethered cord dangerous?
It can cause progressive neurological loss if untreated. Outcomes are good with early surgery.
Will there be improvement after surgery?
Pain usually improves. Motor functions stabilize or partially improve. Bladder function is variable.
Can re-tethering occur?
Re-tethering may develop in 5-10% of cases. Regular follow-up is important.
Other Treatments
Spine Surgery
Surgical treatment of spine and spinal cord diseases
Deformity Surgery
Deformity surgery is the surgical correction of scoliosis, kyphosis, and spinal imbalance. Effective treatment is achieved with modern techniques and implants. Prof. Dr. Salim Şentürk's expertise in complex deformity surgery.
Endoscopic Spine Surgery
Endoscopic spine surgery is a minimally invasive technique performed through an 8 mm incision. Same-day discharge and rapid recovery are possible for lumbar and cervical disc herniations. Prof. Dr. Salim Şentürk's endoscopic surgery expertise.
Peripheral Nerve Surgery
Peripheral nerve surgery treats nerve compressions, injuries, and tumors. Carpal tunnel, cubital tunnel, and nerve tumors are treated surgically. Prof. Dr. Salim Şentürk's nerve surgery expertise.
Reviewed by: Prof. Dr. Salim Şentürk, Neurosurgeon
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