Question of the Month: I am 36 years old. It was confirmed by an MRI a couple of months ago that I have another tethered cord. I had one about 9 years ago and as a result I now have a colostomy and am in my chair full time. What should I do?

From your question I am uncertain if you have previously had a tethered cord release which resulted in the colostomy and decreased mobility or if you have not ever had surgery.

If you already had a tethered cord release, it is very common to have MRI evidence of retethering. MRI findings of tethered cord may or may not be associated with tethered cord symptoms such as you described (bowel/bladder symptoms, pain, decreased mobility). Thus, just because you have recurrent tethered cord findings on your MRI does not mean that surgery will improve your symptoms.

If you have not yet had a release, your symptoms may be improved with surgery by a neurosurgeon with experience in tethered cords.

From a surgical standpoint, the number of previous tether cord releases makes a difference on the outcome of each successive surgery. There seems to be diminishing benefits from each subsequent tethered cord release, particularly for adults. Therefore, it is best to discuss what you hope to achieve from the surgery with the neurosurgeon to determine if these goals are likely to be achieved. From anecdotal reports of neurosurgeons affiliated with the SBA, it seems that pain can be improved but not necessarily completely resolved. Unfortunately, retethering after any surgery is likely and whether the pain returns or further loss of function occurs cannot be predicted.

Please see the May 2009 Ask the Doctor question and response in the archives for more information on tethered cord.

For past questions and answers visit the Ask the Doctor archive.