Tethered Cord

Tethered Cord

A tethered cord is a congenital or, in the broader definition, an acquired adhesion of the lower parts of the spinal cord. The adhesions are usually located near the conus medullaris and can cause neurological deficits, for example. The treatment is an operation.

What is tethered cord?

The human spinal cord tapers conically at the caudal end. This area is called the conus medullaris or medullary cone and runs out at its tip in the form of a thread and together with the filum terminale, the so-called end thread. The caudal portions of the spinal cord can attach pathologically and generate increased tension on the nerve fibers located in the lower spinal cord. For what does l1cam syndrome stand for, please visit ezhoushan.net.

In the case of a corresponding clinical picture, there is talk of a tethered cord. Literally translated, “tethered cork” means “tethered cord”. In most cases, neurological deficits are associated with the clinical picture, which are generated by the train on the nerve fibers. Under certain circumstances, a tethered cord is associated with the so-called cone syndrome, a neurogenic deficit as a result of pressure on the caudal parts of the spinal cord.

According to ICD-10, the clinical picture of tethered cork is classified as a congenital malformation of the spinal cord. In the broader definition, however, the condition does not necessarily have to be congenital, but can also be acquired later through different processes.

Causes

The narrow definition of the tethered cord is based on a congenital malformation of the spinal cord. The most common cause in this context is a meningomyelocele or spina bifida. This is a neural tube malformation that can develop between the 22nd and 28th day of embryonic development.

Neural ear malformations are abnormal processes during primary neurulation. Other causes of tethered cord can be hidden glitches. be. Such disturbances can correspond, for example, to a fatty infiltration in the sense of a lipomatosis of the filum terminal. Such a phenomenon hinders the ascent of the cone in the growth process.

In the broader definition, scarring after surgery on the lumbar spine can also be responsible for the tethered cord phenomenon. In this context, the filum terminale or other extensions of the spinal cord may, for example, fuse with the spinal cord sheath in a fibrous cord.

Symptoms, Ailments & Signs

Because of the attachment, tethered cord patients experience more or less intense pressure on the lower sections of the spinal cord. The conus medullaris is at an unusual depth. Because of the cone depression, traction is exerted on the spinal cord. Neurological disorders can occur.

Some of the most common disorders include sensory disturbances up to and including numbness on the inside of the thighs. Disorders of urination or disorders of the sexual function are also conceivable symptoms with a neurogenic background. Apart from the neurological disorders, the congenital phenomenon of tethered cord manifests in part in a spina bifida aperta, i.e. a visible cleft formation in the spine.

In addition, many patients suffer from external signs such as atypical hair growth or nevi in ​​the immediate vicinity of the lesion. A little more rarely, there is also a size difference between the two feet in the congenital form. In about a quarter of all cases, a meningomyelocele is observed in patients with a tethered cord.

Diagnosis & course of disease

The diagnosis of tethered cord for the congenital form is usually made in the newborn or at least in infancy. The diagnosis consists of visual diagnosis and sonography. If there are no visible abnormalities in the area of ​​the lesion, the diagnosis can take place much later and is then usually carried out using magnetic resonance imaging.

In later diagnoses, observed failure symptoms of the nervous system usually give reason to consult a doctor. For patients with tethered cord, the prognosis depends on the extent and correctability of the adhesions.

Complications

Various neurological disorders can occur in connection with a tethered cord. Most commonly, there is numbness in the legs or even complete numbness on the inner thighs. In addition, micturition disorders and disorders of sexual function can occur.

The disease can also be associated with a visible cleft formation in the spine, a so-called spina bifida aperta. Many patients also suffer from atypical hair growth or skin and mucous membrane malformations in the area of ​​the disease. Occasionally the toes of both feet are different sizes. The cosmetic abnormalities usually also represent a psychological burden for those affected.

Severe deformities in particular can lead to the development of mental illnesses and exclusion or withdrawal from social life. Surgical treatment of the symptoms is always associated with certain risks. Bleeding or nerve damage, for example, occasionally occurs during the procedure.

Infections and postoperative wound healing disorders cannot be ruled out either. If the patient takes medication, the side effects and interactions typical of the respective preparation can occur. Some people are also allergic to certain dressing materials or active ingredients.

When should you go to the doctor?

In the case of the disease tethered cord, a doctor should always be consulted so that there are no further complaints and compilations that could limit the quality of life of the person concerned. Therefore, a doctor should be contacted at the very first signs and symptoms of the disease. This is the only way to prevent further complaints. The earlier the tethered cord disease is recognized and treated, the better the further course of the disease.

As a rule, a doctor should be consulted with tethered cords if the person concerned suffers from significant emotional disturbances. Furthermore, problems with bowel movements or going to the toilet can indicate the disease and should be examined by a doctor if they persist over a longer period of time. In many cases, the sexual function of the person affected is also disturbed by the disease tethered cord.

In the first place, a general practitioner can be contacted for these complaints. Further treatment depends on the exact underlying disease.

Treatment & Therapy

In tethered cord patients, adhesions disrupt the physiological anatomy and function of the spinal cord. The treatment of choice in this case is causal treatment. In short, the adhesions must be removed in order to be able to eliminate all the symptoms of the phenomenon. With this goal, an operation is arranged. Non-invasive procedures are out of the question for treatment.

The spinal cord must be relieved of the pressure caused by the adhesions. After the surgical relief of the spinal cord, more or less impairing limitations may remain. Targeted physiotherapy can be useful , for example, to combat residual movement disorders.

If sensory disturbances remain, resensitization can be attempted. Since the spinal cord is part of the central nervous system, the nerve tissue located there is highly specialized. For this reason, once damage to the spinal cord has occurred, it is difficult to reverse.

Scar tissue may remain after prolonged traction from the adhesions. There is no longer any transmission of stimuli in the area of ​​the scar tissue. However, with targeted training, it is possible for neighboring nerve cells to take over the functions of defective nerve cells.

Prevention

The tethered cord phenomenon is difficult to prevent in its congenital form. During the period of embryonic development, exposure to minute toxins can cause developmental disorders. The smallest toxins are in the environment and can therefore perhaps be minimized by the pregnant woman, but not completely avoided.

An acquired tethered cord can be prevented in moderation by back school and back training. These measures have long been considered prophylactic measures for herniated discs. Since the adhesions in the acquired form are often the result of a herniated disc, all disc health measures apply to prevent this.

Aftercare

Complaints caused by tethered cord can be alleviated by special measures during aftercare. After the spinal cord has been relieved by a surgical procedure, individual physiotherapy is offered to the patient. This helps to work against any movement disorders that are still present. If sensory disturbances occur, resensitization is possible.

For this special aftercare, the doctor provides comprehensive advice, which those affected should also follow. In this way, the nerve tissue on the spinal cord receives targeted support. Scars may form as a result of the operation. The scar tissue often takes a long time to recede due to adhesions.

As a result, problems with the transmission of stimuli can arise. However, regular, targeted training stimulates the neighboring nerve cells to take over the task of the damaged nerve cells. Participation in a back school is therefore recommended for those affected.

The doctors provide all the important information about back training, which makes sense for both aftercare and prophylaxis. The adhesions are often caused by a herniated disc. In order to minimize the risk of the disease, all measures for better intervertebral disc health are worthwhile. Pelvic floor exercises, extended physiotherapy and orthopedic insoles can also help.

You can do that yourself

Patients with a tethered cord suffer, among other things, from complaints that reduce their mobility and can thus impair their quality of life. Since the disease in some cases remains undetected for a long time, it is initially the responsibility of those affected to speed up diagnosis. Only then can effective and targeted self-help measures be started.

After a medical diagnosis, for example, regular visits to physiotherapy are recommended. The patients use tethered cords to train special movement sequences and muscles that serve to alleviate their symptoms. In order to promote the success of physiotherapy, those affected also carry out the exercise units outside of the therapeutic courses. Complaints caused by foot deformities and gait disorders can be reduced, at least in part, by appropriate orthopedic therapy and shoe inserts. For this it is necessary that the prescribed insoles are worn daily.

To combat incontinence, patients can train their pelvic floor muscles on the one hand and take medication prescribed by their doctor on the other. Recurring infections of the bladder must be treated in any case, as otherwise kidney diseases can develop in the long term. In general, patients have to coordinate numerous appointments with various specialists in their own interest and attend them regularly.

Tethered Cord