What is Tethered Cord Syndrome?

Many diseases are caused by congenital and acquired factors. Different types of diseases include different causes, symptoms, and physical characteristics. The human body has a spine, and it is precisely because of this key part that spinal cord thrombosis also includes tethered cord syndrome, which is caused by various congenital diseases and acquired reasons. It will cause damage to the spinal cord and spine, produce neurological functional disorders, and severe deformities. Spinal problems will affect the activities and motor nerves, so the patient's body will be accompanied by pain and movement disorders all year round, and even the urinary system and normal physiological system will be affected.

Symptoms and signs

Symptoms and signs of tethered cord syndrome

The clinical manifestations of tethered cord syndrome are complex. The different onset of symptoms, different combinations of symptoms, and different congenital malformations make the clinical manifestations complex. However, these clinical manifestations can be attributed to different neurological dysfunctions caused by different causes and inducements, and the different time and degree of traction of the conus medullaris. Common clinical symptoms and signs are:

1. Pain

It is the most common symptom, manifested as indescribable pain or discomfort, which can radiate but often has no skin segment distribution characteristics. The pain site in children is often difficult to locate or is located in the lumbar sacral region and can radiate to the lower limbs. In adults, it is widely distributed and can be located deep in the anorectum, mid-buttocks, tail, perineum, lower limbs and low back, and can be unilateral or bilateral. The nature of the pain is mostly diffuse pain, radiating pain and electric shock-like pain, with little dull pain. The pain is often aggravated by sitting for a long time and bending the body forward, and rarely aggravated by coughing, sneezing and twisting. The straight leg raising test is positive and may be confused with the pain of intervertebral disc herniation. A blow to the lumbar sacral region can cause severe discharge-like pain, accompanied by transient lower limb weakness.

2. Movement disorders

The main symptoms are progressive weakness of the lower limbs and difficulty walking, which may affect one side or both sides, but the latter is more common. Sometimes the patient complains of unilateral involvement, but examination reveals changes on both sides. The lower limbs may have both upper motor neuron and lower motor neuron damage, that is, disuse muscular atrophy with increased muscle tone and hyperreflexia. In the early stages of childhood patients, there is usually no or only lower limb movement disorder. Symptoms appear with age and progressively worsen, which may manifest as asymmetry in length and thickness of the lower limbs, valgus deformity, skin atrophic ulcers, etc.

3. Sensory impairment

The main symptom is numbness or decreased sensation of the skin in the saddle area.

4. Bladder and rectal dysfunction

Bladder and rectal dysfunction often occur at the same time. The former includes enuresis, frequent urination, urgency, urinary incontinence and urinary retention, and the latter includes constipation or fecal incontinence. Enuresis or urinary incontinence are the most common in children. According to bladder function tests, it can be divided into spastic small bladder and hypotonic large bladder. The former is often accompanied by spastic gait, frequent urination, urgency, stress urinary incontinence and constipation, which is a manifestation of upper motor neuron damage; the latter is manifested by low-flow urinary incontinence, increased residual urine volume and fecal incontinence, etc., which is a manifestation of lower motor neuron damage.

5. Abnormal skin in the lumbar region

90% of pediatric patients have subcutaneous masses, 50% have skin sinuses, meningocele, hemangioma and hirsutism. About 1/3 of the children have subcutaneous lipomas growing on one side and meningocele on the other side. The subcutaneous masses in the lumbar and sacral regions can be very large, which attracts the attention of parents due to aesthetic issues. Some children may have skin tags in the sacrum, forming a tail. The above skin changes occur in less than half of adults.

6. Precipitating and aggravating factors

①Children’s growth and development period;

②In adults, it occurs in activities that suddenly pull the spinal cord, such as kicking the legs upward, bending forward, childbirth, exercise, or traffic accidents when the hip joint is forced to flex forward;

③Spinal stenosis;

④ Trauma, such as back injury or falling on the buttocks.