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Tethered Spinal Cord Syndrome (TSC)

Tethered Spinal Cord Syndrome (TSC) Treatment in Delhi, India

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Overview

The tethered spinal cord, also known as tethered spinal cord syndrome, is a neurological disorder caused due to tissue attachment, limiting the movement of the spinal cord. It occurs when the spinal cord gets attached to the tissue around the spine, commonly at the base of the spine.

This can lead to abnormal stretching of the spinal cord, causing complications such as nerve damage, severe pain, and other conditions. The spinal cord's inability to move can cause problems and affect the daily activity growth and development of a child.

Tethered spinal cord occurs commonly in children, especially children with spina bifida.

The condition is treatable when diagnosed and treated early. Surgery is the most widely used treatment to detach the spinal cord from the spinal tissue.

Tethered Spinal Cord Syndrome Symptoms

The symptoms of tethered spinal cord vary from age to age. In rare cases, few children may not experience symptoms until an older age. Symptoms of the tethered spinal cord in children include:

  • Bump, hairy patch, or dimple on the lower back
  • Discolouration in the lower back
  • Unusual anatomy of the genitals and anus
  • Uneven length of the leg (one shorter or larger than the other)
  • Pain in the lower back
  • Numbness and tingling sensation in the legs
  • Problems while standing or walking
  • Loss of bladder control

Early symptoms of the tethered spinal cord often go undiagnosed; in such cases, major symptoms such as bowel, sensory, motor, and bladder control problems emerge. If the syndrome is not treated early, the strain on the spinal cord may increase, leading to long-lasting sensory and motor issues.

Consult a doctor if a child or person experiences or shows any symptoms.

Tethered Spinal Cord Syndrome Causes

In a few cases, children are born with a tethered spinal cord, which occurs during the development of the spine. Children may also develop this condition after birth due to damage to the spinal cord or scar tissue after surgery.

Other causes of tethered spinal cord syndrome include:

  • Tumour in the spine
  • Spina bifida
  • Previous spinal surgery or scar
  • History of spinal trauma

Tethered Spinal Cord Syndrome Diagnosis

The diagnosis depends on the age of the child. The doctor may examine symptoms, ask about the family's medical history and conduct a physical examination of the lower back. Other diagnosis methods include:

  • MRI: MRI is a diagnostic test that uses powerful magnets, high-energy radio waves, and specialised computer technology to produce a 3D image of the body. The image shows the spinal cord, nerve roots, and surrounding area, including the enlargement, displacement, or degeneration of any part.
  • CT scan: CT scan is an imaging test that provides accurate images of the spinal cord, including the muscles, bones, fat, and organs.
  • Myelogram: This is a specialised test to diagnose problems of the spinal cord, nerve roots, and surrounding tissues.
  • Muscle test: The doctor may conduct a muscle test to check for body movements and physical strength.

Tethered Spinal Cord Syndrome Treatment

If tethered spinal cord syndrome (TSC) is diagnosed early, surgery may not be needed. In case of minimum symptoms, careful observation with medications can treat the syndrome. Other treatment options available to treat tethered spinal cord syndrome include:

  • Surgery: In this procedure, the spinal cord is released and detached from the surrounding tissue so that spinal movement can happen easily. A small incision is made during the procedure, and the attached tissues are cut and released in a series of steps. The surgery can take 3 to 6 hours.
  • Physiotherapy: The doctor may recommend physiotherapy to improve muscle strength and body movement. It includes a series of personalised exercises, stretching, and other physical activities.
  • Medications: Depending on the need and condition, the doctor may prescribe medications, non-steroidal anti-inflammatory drugs such as Ibuprofen, or painkillers such as hydrocodone or codeine. Opiates, antidepressants, synthetic opiates, and seizure medications may be given.
  • Osteotomy: An osteotomy is a surgical option available to treat tethered spinal cord in adults. It is a surgical procedure to shorten the spine. It aims to relieve the excessive tension on the spinal cord by removing a part of the cord. This treatment is beneficial to keeping the spinal cord fixated on the spine and preventing retethering of the spine.

In children, early surgical treatment is recommended to prevent neurological deterioration.

Tethered Spinal Cord Syndrome Risk factor

Tethered spinal cord syndrome (TSC) can occur due to many underlying defects of the spine. The various factors that can increase the risk of the syndrome include:

  • Tight filum terminale (strand at the base of spinal cord thickens)
  • Split cord malformation (a part of the spinal cord splits)
  • Lipomeningomyelocele (growth of fatty tissues entangled with spinal cord and nerve roots)
  • Dermoids (benign growth)
  • Dermal sinus tract
  • Myelocyctocele (cyst formation at the base of the spinal cord)
  • Genetic factors

The tethered spinal cord can develop if a person has infections, a spinal tumour, or any scar tissue from previous surgery.

Tethered Spinal Cord Syndrome Prevention

The tethered spinal cord is a disorder that does not spread to other body parts. There are no measures to prevent the condition beforehand. However, major and lifelong complications can be altered and prevented by consulting the doctor on time and successfully treating the tethered spinal cord to prevent irreversible damage.

Tethered Spinal Cord Syndrome Complication

Tethered spinal cord and its surgical treatment may cause a few complications. It may cause side effects and complications such as:

  • Decreased muscle strength
  • Side effects of anaesthesia
  • Excessive bleeding
  • Spinal cord injury
  • Infection
  • Leakage of spinal fluid
  • Motor and sensory dysfunctioning

Prognosis or Outlook for Patients

Timely treatment can stabilise and improve the functioning of the spinal cord. Early diagnosis can help prevent the patient's motor functions as the syndrome progresses with age. In some cases, impairments may not be completely correctable.

Medications and physiotherapy can help a patient to recover faster and lead a normal life.

Reviewed & Updated On

Reviewed by Dr. Amit Batra, Principal Consultant, Neurosciences, Neurology on 27-Mar-2023.


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