In his latest installment to the Total Spine series of instructional videos, Dr. Paul McCormick describes retropleural thoracotomy, a surgical technique used to treat complex spinal conditions of the thoracic and lumbar spine. “Retropleural thoracotomy is an important...
Tethered Spinal Cord
Tethered = fastened or tied down
Tethered cord is an umbrella term for several different conditions. The common factor in all tethered cord conditions is that the spinal cord’s movement is restricted at its base. Therefore, during everyday activities, the spinal cord cannot move up and down inside the spinal canal. Instead, it pulls against the restriction. In some cases this pull on the spinal cord is minimal and unlikely to cause damage. In more severe cases, the pressure can permanently injure the delicate tissues of the spinal cord.
Tethered cord may be congenital (present at birth, a result of developmental malformation) or it may be acquired (arise later in life). Congenital tethering is usually discovered in childhood, but not always. In some cases congenital tethering is not discovered, or not diagnosed correctly, until adulthood. Diagnosis of congenital or acquired tethered cord is relatively rare in adults.
In adults, symptoms of tethered cord often develop slowly, but they can become quite severe. Symptoms may include back pain that radiates to the legs, hips, and the genital or rectal areas. The legs may feel numb or weak, and may lose muscle. Bladder and bowel control may be difficult.
Back pain from tethered cord is often aggravated by bending slightly forward, by sitting upright with crossed legs, or by holding a moderate weight (such as a baby or a stack of books) at waist level. This pattern of pain is sometimes called the “3-B sign” for bending, Buddha-sitting, and baby-holding.
|Causes and Risk Factors|
Tethered cord can occur due to other congenital defects of the spine. The various congenital causes include:
Tethered cord can also arise in a previously normal spine. Possible causes of a tether in a previously normal spine include:
|Tests and Diagnosis|
Adult tethered cord is rare. Red flags that might lead a doctor to suspect tethered cord include any of its symptoms (although the same symptoms can be caused by a number of other spinal cord conditions); a previous diagnosis of a congenital spinal malformation; a history of cancer, infection, spine surgery; or spinal cord injury.
A doctor may test a patient’s muscle strength or ask the patient to move in different ways. A patient may receive magnetic resonance (MR) or computed tomography (CT) imaging, or ultrasound.
Once tethered cord is diagnosed, the surgeons at The Spine Hospital at The Neurological Institute of New York may run a few additional tests. Tethered cord conditions may cause syrinxes, or fluid-filled cysts, elsewhere in the spinal cord. The pressure exerted by a syrinx can also damage the spinal cord. For this reason it is a good idea to scan the entire spinal cord, and potentially the brain, prior to treatment.
The neurosurgeons at The Spine Hospital at The Neurological Institute of New York believe that surgery may not be needed for every adult with tethered cord. In adult patients with no symptoms or minimal symptoms, careful observation may be an appropriate course of action.
When surgery is the best choice, our surgeons tailor the operation to the cause of the tether.
In general, for any type of tether surgery, the bones of the spinal column are opened from behind to expose the full extent of the spinal cord tethering. The cause of the tether is identified, carefully isolated and released to relieve any further tension on the spinal cord.. Our doctors often work collaboratively with neurophysiologists to monitor spinal cord and nerve function during the delicate operations. This precise monitoring can help minimize risk to the spinal cord, nerves and nerve roots.
|Preparing for Your Appointment|
Drs. Paul C. McCormick, Michael G. Kaiser, Peter D. Angevine, Alfred T. Ogden, Christopher E. Mandigo, Patrick C. Reid, Richard C.E. Anderson (Pediatric), and Neil A. Feldstein (Pediatric) are experts in treating tethered cord in adults. Each can also offer you a second opinion.
Helpful Surgery Overviews
Dr. McCormick will choose the treatment method specific to each patient and situation. Some of the condition’s treatment options may be listed below.
Dr McCormick video on microsurgical resection of a synovial cyst causing severe lumbar spinal stenosis published in Operative Neurosurgery
Synovial Cysts are a benign and fairly common condition in adult patients. They can arise in most joints throughout the body. In most cases they are asymptomatic but in the spine they can enlarge to produce severe spinal stenosis and pressure on the spinal nerves...
Dr. McCormick invited speaker at 37th Annual Meeting of the Joint Section on Disorders of the Spine and Peripheral Nerves
Dr. McCormick was a featured speaker at the recent 37th Annual Joint Spine Section Annual Spine Summit meeting held in San Diego. He presented at the Innovative Technology Special Session: Operative Video Segments. His presentation was entitled “Intramedullary Tumor,...