Tethered Cord Syndrome (Spinal Dysraphism) in Children – The Role of Intraoperative Neuromonitoring
Understanding Tethered Cord Syndrome
In a healthy individual, the spinal cord is a flexible structure that moves freely within the vertebral canal. This movement accommodates growth and physical activities such as bending and stretching. However, tethered cord syndrome (TCS) or spinal dysraphism involves malformations of the spinal cord that restrict its mobility. These malformations often present with neurological deficits, where the spinal cord is abnormally attached to tissues around the spine, commonly at the base. These attachments cause abnormal stretching of the spinal cord, potentially leading to nerve damage and movement issues. Although primarily seen in children, symptoms can manifest in adulthood as well.
Causes of Tethered Cord Syndrome
Normally, the tip of the spinal cord is located opposite the disc between the first and second lumbar vertebrae in the upper part of the lower back. In conditions such as myelomeningocele, the spinal cord fails to separate from the skin during embryonic development. This failure prevents the normal ascent of the spinal cord, causing it to stay low or tethered. Other causes include:
– Lipomyelomeningocele: The spinal cord has fat at the tip along with the thecal sac (the fluid sac in which the spinal cord usually ‘floats’), which connects to the surrounding tissues or skin.
– Dermal Sinus Tract: A small, dimple-like opening in the skin that can connect to the spinal cord.
– Split Spinal Cord (Diastematomyelia): The spinal cord is split into two.
– Thickened or Tight Filum Terminale: An abnormal thickening of the terminal end of the spinal cord.
Symptoms in Children
Children with tethered cord syndrome may present with various symptoms, including:
– Skin Discoloration on the Lower Back: Often a sign of underlying abnormalities.
– Tuft of Hair on the Low Back: Another visible indicator.
– Lesion or Swelling in the Low Back: May suggest the presence of a tethered cord.
– Fatty Tumor or Dimple on the Lower Back: Visible markers.
– Back or Leg Pain, Numbness, or Tingling in the Lower Extremities: Indicates nerve involvement.
– Leg Deformity, Abnormal Gait, Decreased Strength in the Limbs, Scoliosis: Physical manifestations of the condition.
– Urinary Incontinence and Bowel Dysfunction: Due to nerve damage affecting bladder and bowel control.
Diagnosis and Treatment
If left undiagnosed in childhood, tethered cord syndrome continues into adulthood, causing increased strain on the spinal cord. This can lead to motor and sensory problems, as well as loss of bladder and bowel control. Diagnosis is primarily made through imaging studies:
– MRI: Visualizes the spinal cord, nerve roots, and surrounding tissues, showing displacement and associated lesions.
– CT Scan with Myelogram: Provides detailed images of the spinal cord and surrounding structures.
– Ultrasound of the Lower Back: Useful in some cases for visualizing the tethered cord and associated anomalies.
Surgical Intervention
Surgery is often required if clinical signs or symptoms of deterioration are present. The procedure, known as untethering of the spinal cord, involves dissecting and freeing the cord from scarred tissues and attachments. Intraoperative neuromonitoring is crucial during this surgery, as it allows for real-time monitoring of nerve function, minimizing the risk of nerve damage. Despite the potential benefits, the overall complication rate for this surgery is around 2%.
Recovery and Prognosis
Post-surgery, children typically resume their normal activities within a few weeks. However, recovery of lost muscle power and bladder function depends on the degree and duration of preoperative symptoms. Early diagnosis and intervention are critical for the best outcomes.
Why Choose Hannah Joseph Hospital?
At Hannah Joseph Hospital, we are dedicated to providing comprehensive care for children with tethered cord syndrome. Our multidisciplinary team of pediatric neurosurgeons, neurologists, and rehabilitation specialists work together to deliver personalized treatment plans. We utilize advanced diagnostic tools and state-of-the-art surgical techniques, including intraoperative neuromonitoring, to ensure the best possible outcomes for our young patients.
Our Commitment to Quality Care
Choosing Hannah Joseph Hospital means entrusting your child’s care to a team that prioritizes safety, precision, and compassion. We are committed to improving the quality of life for children with spinal dysraphism through early diagnosis, effective treatment, and ongoing support.
If you have concerns about tethered cord syndrome or other pediatric neurological conditions, contact Hannah Joseph Hospital today. Our team is here to provide expert care and guidance every step of the way.
