Tethered Cord syndrome is caused by tissue attachments that limit the movement of the spinal cord within the spinal column.

Presentation:

In children tethered cord most commonly associated with myelomeningocele (spina bifida) and appears to be the result of improper growth of the neural tube during fetal development causing an abnormally low conus medullaris with a short, thickened filum terminale or intradural lipoma.  

In children, symptoms may include lesions, hairy patches, dimples, or fatty tumors on the lower back; foot and spinal deformities; weakness in the legs; low back pain; scoliosis; and incontinence. 

Back and leg pain, club foot, scoliosis, gait problems. Continuous urinary dribbling, delayed toilet training, recurrent UTIs. Cutaneous stigmata: tuft of hair, dimple, capillary angioma.

Work up:

MRI imaging is often used to evaluate individuals with these symptoms, and can be used to diagnose the location of the tethering

Treatment:

In children, early surgery is recommended to prevent further neurological deterioration. Regular follow-up is important: retethering may occur in some individuals during periods of rapid growth and may be seen between five to nine years of age.