Children & families · Conditions
Tethered spinal cord
The lower end of the spinal cord is held down, so it stretches as a child grows. It may be linked to spina bifida or to skin markers on the lower back.
What is it?
Normally the lower end of the spinal cord moves freely inside the spinal canal. In a tethered spinal cord, it is held down by tissue such as a thickened band (filum terminale), a fatty lump (lipoma, as in lipomyelomeningocele), a dermal sinus tract, or scar tissue after spina bifida closure. As a child grows, the spinal cord may be stretched, which can affect the nerves to the legs, bladder and bowel.
What symptoms can it cause?
Some children have no symptoms. Others may have back or leg pain, leg weakness or numbness, changes in walking, foot deformities, worsening curvature of the spine (scoliosis), or changes in bladder or bowel control, such as new wetting in a child who was previously dry. Signs on the skin of the lower back, such as a fatty lump, a tuft of hair, a dimple above the crease of the buttocks, a red or purple mark, or a skin tag, can be a clue.
How is it assessed?
Your child will be examined, including the back, legs and walking. An MRI scan of the spine shows the position of the spinal cord and the cause of tethering; in young babies an ultrasound may be used first. Tests of bladder function (urodynamics) are often helpful, both before and after treatment.
What are the treatment options?
Children without symptoms are often watched with regular review. When symptoms are present or developing, the usual treatment is surgery to release (untether) the spinal cord. This is done with intraoperative neuromonitoring, which checks the function of the nerves during the operation.
When might surgery be considered?
Surgery may be considered when there are symptoms or signs of progression, such as new weakness, pain or changes in bladder function, and in some children with particular causes of tethering, such as a dermal sinus tract, because of the risk of infection. The options, benefits and risks are discussed with you in detail.
What to expect from recovery and follow-up
Most children stay in hospital for a few days and are asked to lie flat for a short time after surgery. Surgery aims to stop symptoms getting worse; some improve, particularly pain. The spinal cord can re-tether as a child grows, so follow-up continues through childhood, often with the urology and physiotherapy teams.
When to seek urgent help
If your child is very drowsy, difficult to wake, has a seizure, repeated vomiting or a severe headache, go to the nearest emergency unit or call 10177. If your child is under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600). New leg weakness, numbness, back pain or changes in bladder or bowel control also need prompt review.
This page is general information for parents and caregivers. Your child's doctor will advise on what applies to your child.