Releasing the tethering lesion; can be simple or highly complex requiring many hours or dissection under the microscope. This condition is closely associated with spina bifida, a birth defect in which the spinal cord does not close properly during fetal development. But if your child has pain or bladder problems from a tethered cord, surgery to untether the spinal cord and to collect urine is the best option to prevent further damage and health problems. Tethered Cord What is ‘tethered cord’? If left untreated, this condition can lead to neurological damage as the child grows and the stretching increases. At the time of birth the mylomeningocele is separated from the skin but the spinal cord is still stuck in the same place. Bladder and bowel control may be difficult. Fax: 214-456-2497 Hoffmann HJ, Hendrick EB, Humphreys RP (1976) The tethered spinal cord: its protean manifestation, diagnosis and surgical correction. Tethered cord syndrome is a rare neurological condition. Some problems with the bladder related to a tethered cord cannot be prevented. Some children have medication or physical therapy to help relieve pain from a tethered cord. Nerve damage can keep the bladder from emptying as it should. When part of the spinal cord is stuck in place, the cord slowly stretches as a baby gets bigger. Gemeint ist damit eine krankhafte Anheftung im unteren Bereich des Rückenmarks, wodurch ein zu starker Zug auf die Nervenfasern entsteht. What are the symptoms of tethered spinal cord? Most of these patients have their spinal cord tethered or stuck to the lower end of the spine. Toggle mobile navigation and focus the search field, Back pain, which worsens with activity and improves with rest, Bowel and bladder problems, such as incontinence, Fatty tumor or deep dimple on the lower back, Leg pain (especially in the back of the legs), Lesion (a sore or infection) on the lower back, Dermal sinus tract – scaly channel of tissue along the spinal cord that is prone to infection and other complications, Lipomyelomeningocele – birth defect that causes a fatty mass under the skin of a child’s back, which may pull on the spinal cord, Preparing for Your Visit or Stay at Children's. Das Syndrom des „gefesselten Rückenmarks“ (Tethered Cord Syndrom) bezeichnet also den klinischen Symptomkomplex, der als Folge einer caudalen Rückenmarksfehlbildung entsteht, die das Rückenmark im Spinalkanal fixiert, was von Sonderformen (siehe unten) abgesehen die physiologische Aszension des Rückenmarks verhindert. Dem Rückenmark sind über die Spinalnerven wesentliche Anteile des peripheren Nervensystems angeschlossen. Surgery for a tethered spinal cord can prevent future irreversible nerve damage which can severely affect a child's bladder and leg function and quality of life. Trouble with bowel or bladder control, such as difficulty in toilet training in a toddler, keeping a dry diaper with a baby, loosing control in a toilet trained child or no being able to hold urine until getting to the bathroom. Every single thought and opinion is completely my own. If your child begins to show symptoms such as pain, muscle weakness, incontinence (leaking of urine) or other bladder trouble, doctors may recommend surgery as soon as possible to prevent further damage from your child’s growth. In a baby with Spina bifida the spinal cord is still attached to the skin around it preventing it from rising properly. Surgery to untether your child’s spinal cord does not correct damage that already has occurred. The improper growth can cause the cord to attach to the spinal column instead of floating freely as it should. These attachments cause an abnormal stretching of the spinal cord. Soon after conception, as a baby develops in the womb, cells form to- gether to build the spinal column. During development of the spinal cord, tissue and fat, or other body elements that do not belong near the spinal cord can become attached to the spinal cord. All rights reserved. The condition can be treated with surgery to prevent future nerve damage. Doctors also monitor children who have had surgery because a small percentage of children who have surgery to untether a cord require a second surgery when the cord tethers again. Usually, as your child develops, the spinal cord ends at a point in the lower back where it is not attached to any skin or other structure. It can even occur in adults. At Children’s Health, our urology team can use a robot to operate in very small spaces of the body, which means a smaller incision, and a way to help children empty their bladders on their own. A tethered spinal cord is one in which the spinal cord nerves grow attached to a spot on the spine. This occurs most commonly in the lower part of the spine. This does not usually require surgery unless your child is symptomatic. To learn about all the ways we are working to keep you, your family and our team members safe, visit our COVID-19 updates page. However, a tethered spinal cord does not move; it is pulled tightly at the end. The neurological surgeon makes an incision in the lower back to expose the site where the spinal cord is pinned, then frees it by releasing the stuck portion of the cord. For people living with Spina Bifida, their spinal cord at birth is usually low-lying or tethered. The diagnosis of a tethered spinal cord is made by obtaining a Magnetic Resonance Imaging or MRI of the spine. : Hi! Babies with spina bifida occulta usually do not need treatment immediately after birth. In most cases, there are no problems at birth. My DD2 is 3 months old, and has had a 'crooked bum crack' since birth. It is pulled tight, where normally the spinal cord hangs loose in the spinal canal. Patients may present with any combination of the following 4: 1. progressive leg weakness or sensory loss 2. disturbance of bowel or bladder function 3. low back pain or sciatica 4. spinal deformities such as scoliosis 5. foot deformities such as pes cavus 6. cutaneous stigmata of spinal dysraphism(e.g. Had her at the doc today, and she said she suspected possible tethered spinal cord, and is sending us for u/s and MRI. Children who have a tethered cord but no symptoms should have surgery as soon as symptoms appear, so parents and doctors should closely monitor these children. A tethered spinal cord occurs when the spinal cord is attached to tissue around the spine, most commonly at the base of the spine. Medical Arts Plaza Building, Request an Appointment with codes: Urology. The spinal cord carries important signals to and from the brain to control muscles and functions in the body. Children with a tethered cord who receive appropriate treatment can have a normal life expectancy. A tethered spinal cord can cause problems from the time your infant is born, or as your child grows, depending on the cause and severity of the disorder. Parents can watch for symptoms of neurogenic bladder and help their children follow all instructions from doctors to manage problems with controlling urination, including home instructions following surgery. A follow-up MRI is usually performed sometime after surgery. The legs may feel numb or weak, and may lose muscle. In adults, symptoms of tethered cord often develop slowly, but they can become quite severe. Tethered Spinal Cord is in almost all cases accompanied by a condition called as spina bifida. Tethered spinal cord refers to a condition where the bottom of the spinal cord is pulled down and fixed or stuck in a position instead of floating freely. (Photo 3), A crooked crease between the buttocks. Abstract. Trouble with bowel or bladder control, such as difficulty in toilet training in a toddler, keeping a dry diaper with a baby, loosing control in a toilet trained child or no being able to hold urine until getting to the bathroom. Schematic drawing of the surgical procedures for spinal lipoma of a dorsal type with tethered cord. Here is Adam's story. Suite F4300, 214-456-2444 (Photo 4). For this procedure, the patient is placed under general anesthesia. If your child already had a neurogenic bladder, or inability to control the bladder and urine flow, an experienced pediatric urologist will recommend treatment for the bladder problem. 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