Question of the Month: I am an adult with Spina Bifida. Is tethered cord release surgery going to cure me of tethering cord or will it eventually tether again? What can I expect following surgery?

Tethered cord is a difficult topic because almost everyone who had a myelomenigocele surgery develops a tethered cord. The spinal cord can become tethered to an immobile part of the lower spinal area. This happens for many reasons, one of which is the healing and scar tissue that forms following a tethered cord release. So, it is very common for a released cord to become tethered again. The tricky part is determining if a tethered cord (usually found on MRI of the spine) is causing problems or symptoms, such as back pain.

Adults versus children
In children, the most common reason for tethered cords to become symptomatic is during a growth spurt when the cord would normally ascend up the spinal canal in response to the increase in height. Because it is fixed (tethered) in place, it cannot move upward and causes tension. This is a good reason to untether and most children have less pain.

For adults, who have stopped growing, the more common reason for a tethered cord to become symptomatic is trauma. This can be from a fall, a result of heavy lifting, due to a jolt to the back, or during the pushing phase of childbirth. Since these traumas can also cause mechanical back pain not directly involved with a tethered cord, it is helpful if there are additional findings that indicate the spina nerves are affected. These objective findings include:

• a change in gait,
• inward turning of the feet,
• tripping,
• falling, and
• change in bladder function.

Symptomatic tethered cord
A symptomatic tethered cord can be the case if there is a change in urodynamics or a change in findings on manual muscle testing. Because these tests provide more information when they are compared to results obtained from before the symptoms of tethered cord developed, it is important to have regular follow-up with the providers who perform these tests so that recent “baselines” are in your medical records.

Release Surgery
Tethered cord release surgery has risks, including permanent neurological changes such as:

• loss of sensation and further lower extremity weakness,
• change in gait, and
• occasionally irreversible loss of the ability to ambulate.

Therefore, most neurosurgeons try conservative treatment first. This includes rest, anti-inflammatory medications, and rehabilitation therapy. If the neurosurgeon believes this is a symptomatic tethered cord, it is also important to evaluate the shunt before considering an untethering procedure, because tethered cord symptoms can result from shunt problems.

Because the backs of adults are thicker than children, the surgery is somewhat more involved in adults. The recovery is similar in that there is a period of immobility where the patient must remain flat, followed by a gradual increase in activity. The exact timing of the recovery is patient and surgeon dependent. The individual undergoing surgery should also be aware that during the healing process the cord will likely tether again, which may or may not result in a return of symptoms.

For more information on tethered cord, please visit the Spina Bifida Association fact sheet.

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