What to Do If Your Child Has a Tethered Cord

If you suspect that your child has a tethered cord, you should contact your doctor. There is nothing you can do at home to address the symptoms.

When does my doctor need to be involved? Whenever a tethered cord is suspected, your doctor should be involved. Likewise, contact your doctor if your child is having tin­gling or weakness in his legs and feet or if he is having new-onset constipation and urinary retention.

What tests need to be done, and what do the results mean?
To make the diagnosis, the doctor must visualize the tether. In some cases, an X ray of the spine is sufficient. However, the vast majority of cases require an MRI to show exactly where the tether is located. While an MRI is a very sensitive test, it does not pick up all tethers. Therefore, in cases where a child is experiencing increasing symptoms of a tethered cord despite a normal MRI, exploratory surgery may be performed.

Bowel and bladder function need to be monitored closely. If the nerves traveling to the bowel and bladder have been stretched and injured, they can become permanently damaged. Therefore, even if the tether is repaired with surgery, problems with constipation and recurrent UTIs may persist.

Bladder function is often evaluated by a urologist. Urine cul­tures may be done sporadically to make sure silent infections are not recurring.

Parents generally monitor bowel function at home. If constipa­tion does not resolve and becomes increasingly problematic, a gastroenterologist can help with the situation.

What are the treatments?
If the cord is tethered, surgery is a must. Otherwise, the nerves will become increasingly damaged as the child grows. In the case of a tether at or below the lumbar spine, ongoing nerve injury will affect foot and leg function, as well as the bowel and bladder. The surgery is generally quite simple: a neurosurgeon uses an MRI and the child’s symptoms to locate the tether, then goes into the spinal canal at that point to release the cord.

The cure rate for a tethered cord is quite high, especially if it is diagnosed early, before too many symptoms of nerve damage appear. There are no medicines that can be used in lieu of sur­gery.

What are the possible complications?
The complications of a tethered cord are the same as the symp­toms: nerve damage, depending on where the tether resides. Because lower lumbar tethers are the most common, damage to the nerves going to the feet, legs, bowel, and bladder tend to be the most common neurological complications from surgery.

Other surgical complications include bleeding, infection, and retethering. The cord can retether because the area that is released might have some inflammation, which provides a site for potential scarring.

The longer the tether remains and the more a child grows while the tether exists, the more chronic the nerve damage will be. The longer nerve damage occurs, the more likely it is to become permanent.