Tethered spinal cord is an abnormal attachment of the spinal cord to tissue around it. A tethered cord release is a procedure to separate the spinal cord from tissue that holds it in place. The exact steps will depend on individual needs.
The end of the spinal cord normally hangs and moves freely inside the vertebral column. Abnormal tissue, growth, tightening, or thickening of tissue can restrict movement of the spinal cord. This causes extra stress on the nerves which can cause a range of symptoms known as tethered cord syndrome.
A tethered cord release reduces or removes the tissue that is holding the spinal cord in place. Releasing the tether prevents further nerve damage from occurring. The procedure may relieve some of the current symptoms but some nerve damage may be permanent.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
The doctor may do the following before surgery:
In the time leading up to the procedure:
General anesthesia will be used. You will be asleep during the procedure.
The exact steps of the procedure will depend on the tether and how much surrounding tissue is involved. Most will start with an incision in the low back. The incision will pass through muscle and protective layers of tissue around the spinal cord called the meninges. Sometimes a portion of the bone will need to be removed. The size of the incision will depend on the amount of tissue involved and location of tether tissue. Some options include:
The procedure with may be done with:
Once the spinal cord is free, the internal tissue layers and muscles are closed. If a bone segment was removed it may be reattached. The skin is closed with stitches or a waterproof bond. A bandage will be placed over the area.
Nerves to the legs and bladder will be monitored during surgery to look for any changes. This will help protect nerves from further damage.
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About 3 hours, but more complex procedures may take longer.
Anesthesia will prevent pain during surgery. There will be some pain in the surgical area for the first few days but should fade as the area heals. Pain and discomfort after the procedure can be managed with medications.
The usual length of stay is 4-7 days. If there are any complications, a longer stay may be needed.
In the recovery room blood pressure, pulse, and breathing will be monitored. Recovery may also include:
You will have to lie flat on your back for up to 72 hours after the surgery. This is to prevent cerebrospinal fluid (CSF) from leaking around the spinal cord. CSF is a fluid that surrounds and protects the brain and spinal cord.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
There are also steps you can take to reduce your chances of infection such as:
Recovery time depends on overall health and the amount of surgery needed. Help will be needed at home for daily household tasks and to help care for surgical wounds.
It may take a few weeks to return to normal activity with a slow increase to normal activity. Additional rehabilitation, including physical and/or occupational therapy, may be needed. Therapy may help to recover lost function or teach how to adjust for nerve damage that did not improve with surgery.
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
If you think you have an emergency, call for emergency medical services right away.
American Association of Neurological Surgeons
Healthy Children—American Academy of Pediatrics
Canadian Neurological Sciences Foundation
Caring for Kids—Canadian Paediatric Society
Bui CJ, Tubbs RS, Oakes WJ. Tethered cord syndrome in children: A review. Neurosurg Focus. 2007;23(2):E2. Available at: http://thejns.org/doi/pdfplus/10.3171/FOC-07/08/E2.
Tethered cord. About Kids Health—The Hospital for Sick Children website. Available at: http://www.aboutkidshealth.ca/En/HealthAZ/ConditionsandDiseases/BrainandNervousSystemDisorders/Pages/Tethered-Cord.aspx. Updated November 10, 2009. Accessed December 18, 2017.
Tethered spinal cord. Pediatric Neurosurgery website. Available at: https://pediatricneurosurgery.org/diagnosis/tethered-spinal-cord. Accessed December 18, 2017.
Tethered cord syndrome. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T901069/Tethered-cord-syndrome. Updated December 15, 2017. Accessed December 18, 2017.
Tethered spinal cord syndrome. American Association of Neurological Surgeons website. Available at: http://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Tethered-Spinal-Cord-Syndrome. Accessed December 18, 2017.
Treatments for tethered spinal cord in children. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/conditions-and-treatments/conditions/t/tethered-spinal-cord/treatments. Accessed December 18, 2017.
Last reviewed December 2017 by EBSCO Medical Review Board Donald W. Buck II, MD Last Updated: 8/26/2015