Tethered cord means something like "tied cord" or "tethered spinal cord". This refers to a pathological attachment in the lower part of the spinal cord. This causes excessive tension on the nerve fibers, which can cause various symptoms.
The text below explains everything about the development, symptoms and treatment options. You can also find selected specialists for tethered cord syndrome here.
The human spinal cord in the spinal column becomes thinner and more conical at the lower end. At the tip of this area, known as the conus medullaris or medullary cone , the spinal cord runs out in a thread-like shape.
This terminal filament can be damaged by
to the wall of the spinal canal or to the surrounding tissue. This causes excessive tension on the nerve fibers. This can have various consequences.
In some cases, hardly any symptoms are noticeable and the patient remains symptom-free for a long time or even permanently. More frequently, however, neurological, motor and/or orthopaedic problems occur to varying degrees. If symptoms occur, this is referred to as "tethered cord syndrome".
The course of the disease also varies from patient to patient. In most cases, however, the symptoms increase over time.
Possible signs of the disease are, for example
Congenital tethered cord can also be accompanied by conspicuous skin symptoms. These may include, for example, excessive hairiness or pronounced moles in the areas of attachment.
In tethered cord syndrome, the lower part of the spinal cord (shown here in yellow) is attached to other structures © pixdesign123 | AdobeStock
Significant differences in the size of the feet also occur.
Furthermore, a malformation of the cerebrum can occur. The consequences are, for example, hydrocephalus ("hydrocephalus") or a malpositioning of certain parts of the brain. In later years, this can lead to various problems such as
vital functions.
A primary tethered cord only refers to attachments that are caused by congenital malformations. For example, the clinical picture can be part of the spinal malformation spina bifida (open back).
Secondary tethered cord refers to conditions that only develop in the course of a person's life. This can be caused by surgery or accidents. Tethered cord can also occur when the above-mentioned spina bifida malformation closes or be caused by adhesions following injuries.
Tethered cord may already be suspected during pregnancy. Abnormal findings in amniotic fluid or ultrasound examinations can indicate tethered cord.
After birth, three different diagnostic methods are possible.
The informative value of these procedures is roughly equivalent. They can also be used to detect other malformations or possible involvement of the surrounding tissue.
A tethered cord can only really be treated by surgery. During the operation, the surgeon removes as many adhesions and adhesions as possible so that the tension on the nerve fibers disappears. This improves the neurological, motor and orthopaedic problems, or at least prevents them from getting any worse.
The surgical procedure is called myelolysis, which means "loosening of the spinal cord".
There are different opinions as to who is eligible for the operation. In children, the operation is often carried out as a preventative measure so that major problems do not arise during growth. However, some doctors are of the opinion that surgery should only be performed if symptoms requiring treatment occur.
Myelolysis is a time-consuming operation that can take several hours, depending on the individual severity of the tethered cord.
In a microsurgical procedure, the surgeon completely frees and isolates the spinal cord together with its roots. The end cord is cut. He then removes all superfluous tissue components, such as
In order to prevent new adhesions, the spinal cord should be able to move in as large a cerebrospinal fluid space as possible. The cerebrospinal fluid space is the area that is filled with spinal fluid.
The chances of success of the operation are difficult to estimate in advance, as the benefits often only become apparent later on. In most cases, surgery prevents further deterioration. However, it is also possible for existing problems to improve significantly. The chances of this are particularly high if the operation is performed in early childhood.
However, there are also cases in which symptoms worsen as a result of the operation.
Myelolysis surgery is always associated with an inpatient stay in hospital . It lasts between seven and 12 days. This hospital stay is followed by a recovery period at home of around 14 to 28 days.
Overall, the period of incapacity for work or school averages 32 days.
Depending on the individual case, it takes between six weeks and three months for the patient to return to their pre-operative state of health. During this time, the patient usually undergoes physiotherapy. These can significantly improve the healing process and the final results.
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