Tethered Cord Syndrome in Adults

What is Tethered Cord Syndrome in Adults?

Tethered cord syndrome (TCS) is a rare neurological condition caused by abnormal tension in the spinal cord. This occurs when the spinal cord is improperly attached to surrounding tissues, restricting its movement and leading to stretching as the spine grows or moves. While it is often diagnosed in children, adults with TCS may experience symptoms due to progressive tension or scarring of the spinal cord. Left untreated, TCS can lead to significant neurological and musculoskeletal complications.

Types of Tethered Cord Syndrome

Tethered cord syndrome can be classified based on the underlying cause and the age of onset:

Congenital Tethered Cord Syndrome: This form is present from birth and is associated with spinal abnormalities, such as:

• Spina bifida or myelomeningocele (a type of neural tube defect).

• Lipomas or fatty tumours on the spinal cord.

• Dermal sinuses or tracts, which are small tunnels connecting the skin to the spinal canal.

Acquired Tethered Cord Syndrome: This develops later in life due to:

• Scar tissue from previous spinal surgeries or trauma.

• Spinal tumours or cysts that adhere to the cord.

• Inflammatory conditions, such as arachnoiditis, causing scar formation.

Symptoms of Tethered Cord Syndrome in Adults

Symptoms of TCS in adults can vary depending on the degree of tension and the affected spinal nerves. Common symptoms include:

• Chronic lower back pain that may worsen with movement or prolonged sitting.

• Weakness or numbness in the legs or feet.

• Difficulty walking or maintaining balance.

• Muscle wasting or deformities, such as foot drop.

• Bladder or bowel dysfunction, including incontinence or urgency.

• Pain or tingling sensations radiating down the legs (sciatica-like symptoms).

Symptoms may develop slowly over time or worsen following trauma, physical strain, or surgery.

Diagnosis and Treatment Options

Diagnosis: A comprehensive evaluation is crucial for diagnosing TCS. The following diagnostic tools are commonly used:

• Medical History and Physical Examination: To assess symptoms, neurological function, and potential signs of tethering.

• Magnetic Resonance Imaging (MRI): The gold standard for visualising spinal cord abnormalities, scar tissue, or tumours.

• Ultrasound: Occasionally used for assessing spinal cord movement in specific cases.

• Electrophysiological Studies: Tests such as electromyography (EMG) may be performed to evaluate nerve and muscle function.

Treatment Options: The treatment of TCS in adults focuses on relieving tension on the spinal cord and managing symptoms:

• Surgical Intervention:

  • The primary treatment for symptomatic TCS is detethering surgery, which releases the spinal cord from abnormal attachments.

  • Surgery aims to restore normal spinal cord movement and prevent further neurological decline.

  • In some cases, surgical risks must be weighed carefully, especially if the tethering is complex or due to extensive scarring.

• Non-Surgical Management:

  • For patients with mild symptoms or those unable to undergo surgery, physical therapy and pain management may be considered.

  • Medications, such as muscle relaxants or anti-inflammatory drugs, can help alleviate discomfort.

• Follow-Up Care:

  • Regular monitoring with imaging and neurological evaluations is essential, especially in patients with residual or recurrent symptoms.

  • Rehabilitation therapy, including occupational or physiotherapy, can help improve mobility and quality of life.

Conclusion

Tethered cord syndrome in adults is a challenging but manageable condition with timely diagnosis and treatment. Understanding the symptoms and seeking expert care can help prevent long-term complications and optimise outcomes. At Singapore Brain Spine Nerves Center, our multidisciplinary team offers advanced diagnostic and surgical solutions tailored to your unique needs. If you or a loved one are experiencing symptoms of tethered cord syndrome, contact us today to schedule a consultation and take the first step towards relief and recovery.