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Tethered Cord Syndrome
Tethered Spinal Cord Syndrome or Occult Spinal Dysraphism Sequence:

A neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord. The course of the disorder is progressive. Tethered spinal cord syndrome may go undiagnosed until adulthood, when sensory and motor problems and loss of bowel and bladder control emerge. This delayed presentation of symptoms is related to the degree of strain placed on the spinal cord over time. Tethered spinal cord syndrome appears to be the result of improper growth of the neural tube during fetal development, and is closely linked to spina bifida. Tethering may also develop after spinal cord injury and scar tissue can block the flow of fluids around the spinal cord. Fluid pressure may cause cysts to form in the spinal cord, a condition called syringomyelia. This can lead to additional loss of movement or feeling, or the onset of pain or autonomic symptoms.

Symptoms:

Urinary urgency
Frequency of urination
Urinary incontinence
Urinary retention
Frequency of urination at night
Difficulty starting urinary stream
Constipation
Diarrhea
Occasional incontinence for stools
Decrease interest in sexual relations
Difficulty reaching an orgasm
Decreased sensation in your pelvic area
Low back pain
Leg pain
Numbness under the soles of your feet
Keeping your knees bent at night
Low back pain, leg pain, or urinary symptoms while walking up stairs
History of severe growing pains during childhood and adolescence


Treatment:

Tethered Cord Syndrome is generally treated with an operation called tethered spinal cord release, which allows the spinal cord to move freely.A neurosurgeon makes an incision on a patientís back. The neurosurgeon releases (cuts) the source of a patientís tethering, such as the threadlike filum at the end of the spinal cord, lipoma or scar tissue. Sometimes a small portion of the bony vertebrae (the laminae) is removed to obtain better exposure or to decompress the spinal cord. The neurosurgeon opens the dura (thin layer of matter covering the spinal cord) and gently dissects the spinal cord away from the scarred attachments to the surrounding tissues.

The length of time for the actual operation is approximately 2 to 3 hours, but it can vary depending on how much tethering has occurred. The usual hospital length of stay is 3 to 4 days.

Prognosis:

With treatment, individuals with tethered spinal cord syndrome have a normal life expectancy. However, some neurological and motor impairments may not be fully correctable.


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