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$Unique_ID{BRK04258}
$Pretitle{}
$Title{Tethered Spinal Cord Syndrome}
$Subject{Tethered Spinal Cord Syndrome Occult Spinal Dysraphism Sequence
Tethered Cord Syndrome Tethered Cord Malformation Sequence Tethered Cervical
Spinal Cord Syndrome Congenital Tethered Cervical Spinal Cord Syndrome
Diastematomyelia Spina Bifida }
$Volume{}
$Log{}
Copyright (C) 1990 National Organization for Rare Disorders, Inc.
779:
Tethered Spinal Cord Syndrome
** IMPORTANT **
It is possible that the main title of the article (Tethered Spinal Cord
Syndrome) is not the name you expected. Please check the SYNONYM listing to
find the alternate names and disorder subdivisions covered by this article.
Synonyms
Occult Spinal Dysraphism Sequence
Tethered Cord Syndrome
Tethered Cord Malformation Sequence
Tethered Cervical Spinal Cord Syndrome
Congenital Tethered Cervical Spinal Cord Syndrome
Information on the following diseases can be found in the Related
Disorders section of this report:
Diastematomyelia
Spina Bifida
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Tethered Spinal Cord Syndrome is a disorder characterized by progressive
neurological deterioration due to unnatural stretching of the spinal cord
caused by adhesions on the vertebrae. It most commonly results from
defective closure of the neural tube during embryonic development (Spina
Bifida).
Symptoms
Initial symptoms of Tethered Spinal Cord Syndrome are usually urological and
may include the inability to control urination (incontinence) and repeated
urinary tract infections. Children who have tethered spinal cords usually
show progressive foot and spinal deformities. At birth there is also usually
a characteristic lesion on the skin of the lower back. These lesions may
consist of tufts of hair, skin tags, dimples or fatty tumors. Other symptoms
may include weakness of the lower extremities, inability to control bowel
function (fecal incontinence), low back pain or a combination of these
symptoms.
Adult onset of the disorder is very rare. When it does occur, the
individual initially shows no symptoms. Later, the most common symptom is
diffuse leg pain which may reach as high as the rectum. Progressive sensory
and motor deficits may occur in the lower extremities, as well as bladder and
bowel dysfunction.
Scientists believe that the amount of pulling force (traction) exerted on
the spinal cord, rather than the type or distribution of lesions that are
causing the pulling, probably determines the age of onset of symptoms. Less
severe traction usually produces no symptoms in childhood, but may result in
neurological dysfunction in later life due to repeated tugging at the base of
the spinal cord during natural head and neck flexion, or when the condition
is aggravated by trauma or disease.
Causes
The presence of adhesions on vertebrae is believed to be the cause of
Tethered Spinal Cord Syndrome. These adhesions may be the result of
structural defects arising from improper closure of the neural tube (Spina
Bifida) at approximately 28 days of embryonic development. Failure of proper
development in this area may lead to a wide variety of orthopedic or urologic
symptoms through tethering or compression of the nerve roots.
Children with benign skin tumors (cutaneous hemangiomas) on the lower
back may also have tethered spinal cords. Tethered Spinal Cord Syndrome is
also occasionally associated with diastematomyelia, a disorder characterized
by diversion of the spinal cord by a midline septum during embryonic
development.
Affected Population
Tethered Spinal Cord Syndrome affects males and females equally. First
degree relatives of those with the malformation appear to be at slightly
higher risk of developing it. Individuals with previously repaired defects
of the neural tube are also particularly susceptible to this disorder.
Related Disorders
The following disorders are often associated with Tethered Spinal Cord
Syndrome.
Diastematomyelia is a rare and very serious spinal cord malformation. It
is believed to be caused by genetic or environmental factors during the
embryonic development which causes a longitudinal division in half of the
spinal cord. In some cases, there are abnormalities of the vertebrae due to
the adjustment necessary for encasing the two halves of the spinal cord.
Diastematomyelia is often associated with Spina Bifida (failure of the neural
tube to close completely), clubfoot or Tethered Spinal Cord Syndrome.
Symptoms may include pain, weakness of legs and loss of control over urinary
and fecal functions (incontinence). Surgery during infancy is often
recommended. However, later in life, surgery is performed only if
neurological symptoms develop.
Spina Bifida is a disorder characterized by defective closure of the
neural tube through which the spinal cord may bulge. It may range in
severity from presenting no symptoms to severe neurological disability. One
or more of the individual bones of the spine fail to close completely,
leaving a cleft or defect in the spinal canal. Through such an abnormal
opening, part of the contents of the spinal canal can protrude or herniate.
In mild cases, the disorder may not be diagnosed unless an X-ray is taken,
usually for other purposes (e.g., back injury). (For more information on
this disorder, choose "Spina Bifida" as your search term in the Rare Disease
Database.)
Therapies: Standard
The appearance and recognition of surface lesions on the lower back at birth
should lead to further testing for Tethered Spinal Cord Syndrome. Magnetic
resonance imaging (MRI) is usually the technique of choice for identifying
the tethered spinal cord. Pre-operative evaluation of potential sites of
tethering, based on MRI findings, is very important for planning surgery.
Removal of adhesions at the lower base of the spine through surgery is often
recommended, and results are usually successful. Early management usually
prevents neuromuscular, lower limb or urologic problems. It is usually best
to treat the tethered cord before serious complications become apparent, as
neurologic damage may not be reversible.
In cases where surgical release of the tethered spinal cord is
ineffective, a posterior rhizotomy, in which certain spinal nerve roots are
severed, may be performed to relieve pain.
Therapies: Investigational
This disease entry is based upon medical information available through March
1990. Since NORD's resources are limited, it is not possible to keep every
entry in the Rare Disease Database completely current and accurate. Please
check with the agencies listed in the Resources section for the most current
information about this disorder.
Resources
For more information on Tethered Spinal Cord Syndrome, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
NIH/National Institute of Neurological Disorders & Stroke (NINDS)
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-5751
(800) 352-9424
Spina Bifida Association of America
4590 Macarthur Blvd., NW, #250
Washington, DC 20007-4226
(202) 944-3285
(800) 621-3141
Spina Bifida Association of Canada
633 Wellington Crescent
Winnepeg, Manitoba R3M 0A8
Canada
International Federation for Hydrocephalus and Spina Bifida
c/o RBU
Gata 3
11138 Stockholm Sweden
Contact: David Bagares
References
SMITH'S RECOGNIZABLE PATTERNS OF HUMAN MALFORMATION, 4th ed.: Kenneth Lyons
Jones, M.D.; W.B. Saunders Company, 1988. Pp. 550.
UROLOGIC ASPECTS OF TETHERED CORD. R.C. Flanigan et al.; UROLOGY
(January, 1989: issue 33 (1)). Pp. 80-82.
DIAGNOSIS OF TETHERED CORDS BY MAGNETIC RESONANCE IMAGING. W.A. Hall et
al.; SURG NEUROL (July, 1988; 30 (1)). Pp. 60-64.
TETHERED CORD SYNDROME: A PEDIATRIC CASE STUDY. L. Greif et al.; J
NEUROSCI NURS (April, 1989: issue 21 (2)). Pp. 86-91.
LUMBAR CUTANEOUS HEMANGIOMAS AS INDICATORS OF TETHERED SPINAL CORDS.
A.L. Albright et al.; PEDIATRICS (June, 1989: issue 83 (6)). Pp. 977-980.