A tethered cord means that the spinal cord cannot move freely in the spinal column. When the child bends and moves, the spinal cord is stretched because it is attached ("tethered") to the lower end of the spinal column.
This stretching can cause:
- Back pain
- Loss or change of strength in the legs
- Leg numbness or tingling
- Leg or foot pain
- Loss or change in bladder or bowel control
- Worsening of scoliosis (abnormal curve of the spine)
These symptoms often get worse. They are slow to appear and are hardly noticed when they first appear. Once symptoms occur, they often last a lifetime. A tethered cord can happen at any time during childhood or as an adult.
Causes of tethered cord
- A past operation, such as repair of spina bifida, can build up scar tissue in the spine. The scar tissue causes the spinal cord to stick to the lower end of the spinal column.
- Some spinal cord problems that are present at birth may cause the cord to be fixed to the tissue around it. Such problems include: a fat mass, a double spinal cord (split cord malformation), or a spinal cord tumor. These problems cannot be seen when looking at the child. Often there are clues found in the skin lying over the problems. You may notice a tuft of hair, a birth defect, a tiny hole, a skin tag, or a mass under the skin.
Treatment for tethered cord
All tethered cord patients need surgery to prevent further problems related to nerve damage. Surgery involves gently releasing the spinal cord from the tissue that it is stuck to. This is done by making an incision in the skin, removing some bone from the spine so the spinal cord is exposed. Risks include more problems with the bladder and bowels and more weakness in the legs.
What happens before surgery?
- Your child will need a physical exam, health review, and lab tests.
- Your child will need a Magnetic Resonance Image (MRI) of the brain and spine.
- Stop aspirin, Excedrin, Aleve, and ibuprofen for two weeks before surgery. It is alright to use acetaminophen (Tylenol) if needed.
- Wash your back with Dial Soap twice before surgery. Wash the night before and the morning of surgery with your regular soap, rinse, then use Dial. Wash gently with Dial for 2-3 minutes. Rinse well. Do not use lotions, powders, or perfumes.
- Do not allow your child to eat anything or drink any milk or juice with pulp after midnight the night before surgery. No candy or chewing gum after midnight.
- It is alright to drink clear liquids until 4 hours before surgery.
- Do not allow your child to wear make-up, jewelry, or nail polish to surgery.
Smoking impairs and delays healing. You must quit smoking before surgery. Also, please avoid second hand smoke. If you need help quitting, you can call the Smoking Quit Line at 1-800-QUITNOW or 1-800-784-8669.
What happens after surgery?
- After surgery, your child will need to lie flat on her back, front, or side for one to three days to decrease the chance of a CSF (cerebral spinal fluid) leak from the incision.
- Your child may also have muscle spasms or pain, so pain medicine will be ordered to relieve this.
- Your child will spend one night in the intensive care unit and then moved to the general care floor for 1-2 more days.
- A follow-up appointment will be scheduled in the neurosurgery clinic in 7-10 days. Your child's back dressing and stitches will be removed at that time.
- Please keep the dressing clean and dry. Your child should avoid twisting, pulling, stretching or straining her back until you are told this is allowed.
When to call
You should call the neurosurgery office if you have any questions about the surgery or the symptoms your child may have. Please check the incision twice a day until it is healed. If the incision becomes infected, call right away. Signs of infection are:
- Fever greater than 101.5 F
- Any redness, swelling, or drainage from the incision
Department of Neurosurgery RNs
Lisa (608) 890-6942
Appointments: (608) 263-6420
After hours, nights, and weekend, call the paging operator at (608) 262-0486. Ask for the neurosurgery doctor on call. Leave your name and phone number with the area code. The doctor will call you back.
If you live out of the area, call 1-800-323-8942.
The Spanish version of this Health Facts for You is #6144.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 12/23/2011
Copyright © 12/23/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5335
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