Tethered medulla

What is tethered medulla?

Tethered cord syndrome is a congenital malformation characterized by scar tissue that fixes the spinal cord to the dura, which is the surrounding soft tissue membrane, preventing the normal flow of spinal fluid around the cord and normal movement of the cord within the membrane. This anchorage (fixation) is conducive to the development of cysts.

This pathology is usually diagnosed in childhood although there are patients who manifest symptoms in adulthood.

Prognosis of the disease

If the tethered medulla is treated surgically, the prognosis is good, although the prognosis will decrease with age.

Symptoms of tethered cord

Some of the symptoms of tethered cord are:

  • Back and leg pain
  • Difficulty standing or shifting
  • Deformity, weakness, or numbness in the feet
  • Fecal and/or urinary incontinence
  • Changes in growth of the spine or feet
  • Worsening of scoliosis

These symptoms usually manifest slowly during growth spurts or growth hormone treatments performed to treat short stature.

Is tethered cord syndrome is a congenital malformation.

Medical tests for tethered cord

To confirm the diagnosis of tethered cord, the following tests may be performed:

  • CT scans
  • MRI scans
  • X-rays
  • Ultrasound of the spinal cord
  • Muscle tests
  • Kidney and bladder tests

What are the causes of tethered cord?

Tethered cord is a pathology present from birth, and is caused by abnormal development of the spine during pregnancy. It is sometimes related to other pathologies such as spina bifida and Chiari malformations.

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Can it be prevented?

Tethered medulla cannot be prevented in the first place, but it can be treated so that it does not recur.

Treatments for tethered cord

Tethered cord is treated with surgery, which releases the scar tissue around the cord to restore fluid flow and movement of the cord. A graft is also placed to fortify the dural space and reduce the risk of re-scarring. If cyst formation has occurred, a tube or shunt is inserted to drain the fluid from the cysts.

Although most children will need only one decannulation procedure, some may need more than one.

It is up to the neurosurgeon to decide when and how to perform the surgery.

After surgery, the patient will have to sleep flat on his back, stomach or side for 5 days. After this time, he/she will be able to sit up and get out of bed; if everything goes well, he/she will be discharged and will have a follow-up visit after 7-10 days.

What specialist treats you?

The specialist who treats the tethered cord is the neurosurgeon.