Tethered cord syndrome
ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
The spinal cord hangs loose in the spinal canal, slowly moving upwards during body growth. Tethered spinal cord syndrome is caused by pathological attachment of the spinal cord to the spinal canal, causing an abnormal stretching of the spinal cord during body growth. This syndrome is often associated with spina bifida.
CAUSE OF SYMPTOMS
Gradually (over months, years) progressing thetering of the spinal cord during growth
SYMPTOMS AND SIGNS
An MRI image showing a sagittal and a transverse T2 section of a tethered cord syndrome.
Numbness, pain or weakness (up to complete paralysis) in one or more limbs
Numbness in the genitals or loss of bowel/bladder control
Deterioration in gait
THE DIAGNOSIS IS BASED ON Medical history Clinical exam Magnetic resonance imaging (MRI)
The treatment may be non-surgical or surgical.
Non-surgical treatment may include
Follow-up if there are no or minimal symptoms.
WHEN SHOULD AN OPERATION BE PERFORMED?
Progression of symptoms
WHAT IS THE GOAL OF SURGERY?
Release of the chronic tension on the spinal cord
To improve symptoms (e.g. pain reduction)
To stop the worsening of the symptoms
HOW IS SURGERY PERFORMED?
Untethering via a posterior (from the back) approach
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Tumor of the spine Neuromuscular disease
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