– Tethered cord syndrome is a problem with the growth of the spinal cord.
– Under normal conditions, the spinal bones grow faster than the spinal cord.
– As age progresses, the spinal cord rises to higher levels within the spinal bones.
– The spinal cord can move freely within the canal between the spinal bones.
– If, for any reason, the spinal cord remains at the initial level and becomes tense, tense spinal cord syndrome occurs.
– Normally, the spinal cord in the womb; It extends to the lowest part of the spinal canal. As the baby develops in the womb, the spinal cord remains short compared to the length of the spine and its extensions are lower,
The spinal cord ends 8-10 cm above the canal and extends downwards with its branches.
These branches are shaped like a horse’s tail. However, when there is a lack of formation in the womb, the spinal cord is suspended by a ligament to the coccyx, and as the height increases, this ligament stretches the spinal cord downwards and at the same time, a fat formation (lipoma) may occur here.
– In this syndrome, the spinal cord is attached to the spinal bones.
– It cannot move freely within the channel.
– Tense spinal cord syndrome may be congenital or may occur after surgical interventions on the spine.
– GOS may occur alone, or it may occur together with meningocele, meningomyelocele, lipomeningomyelocele, myelochistocele, diastometomyelia, syringomyelia, and dermal sinus.
Findings seen in tethered spinal cord syndrome
Skin Findings
– Hypertrichosis
– Subcutaneous lipoma
– Dermal sinus
– Hemangioma
Neurological findings
– Loss of strength in lower extremities
– Difficulty in standing
– Muscle atrophy, short extremity
– Sensory disorders
Urological symptoms
– Waist and leg pains
– Orthopedic findings
– Scoliosis
– Pes cavus
– Varus-valgus anomalies
Diagnosis
– Direct vertebral radiographs
– Ultrasonography
– Spinal computed tomography
– Myelography and computed tomography
– MRI is used.
– In direct radiographs, closed midline junction anomaly is almost always seen in the L4, L5, S1 vertebrae.
– In direct vertebral radiographs, spina bifida can be seen in the spicule leading to a separated spinal cord.
– Ultrasonography has diagnostic value in the first 6 months after birth.
However, after the 6th month, it is not useful in diagnosis due to ossification (ossification) in the vertebrae.
– Myelography and computed tomography show GOS adequately, but definitive diagnosis is made with MRI.
– On MRI, the presence of conus medullaris ending below the L3 vertebra level and filament thicker than 2 mm is sufficient for the diagnosis of GOS.
Treatment
– The aim of treatment is to prevent neural damage.
– For this purpose, the patient is closely monitored by Brain and Nerve Surgery Specialists, and surgical intervention is performed on patients who meet the criteria.
– The timing of the surgical intervention is important.
– The intervention should be performed before neural problems related to the bladder (neurogenic bladder) occur.
– In cases of delay, permanent neural damage may occur.
