Tethered Cord Release
(Tethered Spinal Cord Release)
Definition
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.
Reasons for Procedure
The end of the spinal cord normally hangs and moves freely inside the spinal column. Abnormal tissue, growth, tightening, or thickening of tissue can make it hard to move the spinal cord. This causes extra stress on the nerves and 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 lowers the risk of further nerve damage. It may also ease some current systems.
Possible Complications
Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:
- Excess bleeding
- Infection
- Problems from anesthesia, such as wheezing or sore throat
- Damage to the spinal cord
- The need for more surgery if the spinal cord reattaches to tissue
- Problems with muscle strength, or bladder or bowel function
What to Expect
Prior to Procedure
The surgical team may meet with you to talk about:
- Anesthesia options
- Any allergies you may have
- Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
- Fasting before surgery, such as avoiding food or drink after midnight the night before
- Arranging for a ride to and from surgery
- Tests that will need to be done before surgery, such as images of the lower back
Anesthesia
General anesthesia will be used. You will be asleep.
Description of the Procedure
An incision will be made in the lower back. The incision will pass through muscle and protective layers of tissue around the spinal cord. A portion of the bone may be removed.
The exact steps of the procedure will depend on the tether and how much tissue is involved. Some options include:
- Cutting tissue that normally sits around spinal cord but can cause problems in some
- Removing fatty tissue, tumors, or scar tissue
Once the spinal cord is free, the internal tissue layers and muscles are closed. Any bone removed may be reattached. The skin is closed with stitches or a waterproof bond. A bandage will be placed over the area.
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How Long Will It Take?
About 3 hours, but more complex procedures may take longer.
Will It Hurt?
Pain and swelling are common in the first few days. Medicine and home care help.
Average Hospital Stay
The usual length of stay is 4 to 7 days. If you have any problems, you may need to stay longer.
Post-procedure Care
At the Hospital
Right after the procedure, the staff will:
- Give pain medicine
- Monitor nerve function, such as leg movement and urine control
- Have you lie flat on your back for up to 72 hours to prevent cerebrospinal fluid from leaking around the spinal cord
During your stay, the hospital staff will take steps to lower your risk of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping any incision covered
There are also steps you can take to lower your risk of infection, such as:
- Washing your hands often and reminding visitors and staff to do the same
- Reminding staff to wear gloves or masks
- Not letting others touch any incision you have
At Home
It may take a few weeks for the incision and muscles to fully heal. Physical activity will be limited during recovery. You may need to ask for help with daily activities.
Call Your Doctor
Call the doctor if you are not getting better or you have:
- Signs of infection, such as fever and chills
- Redness, swelling, excessive bleeding, or discharge around the incision
- Bulging under the incision
- Changes in bladder or bowel function
- Numbness, tingling, or muscle weakness below the waist
- Pain that you cannot control with medicine
- New or worsening symptoms
If you think you have an emergency, call for medical help right away.
RESOURCES:
American Association of Neurological Surgeons
http://www.aans.org
Healthy Children—American Academy of Pediatrics
https://www.healthychildren.org
CANADIAN RESOURCES:
Canadian Neurological Sciences Foundation
http://www.cnsfederation.org
Caring for Kids—Canadian Paediatric Society
https://www.caringforkids.cps.ca
REFERENCES:
Patient education: wound care. EBSCO Nursing Reference Center website. Available at: https://www.ebscohost.com/nursing/products/nursing-reference-center. Accessed July 22, 2021.
Tethered cord. About Kids Health—The Hospital for Sick Children website. Available at: https://www.aboutkidshealth.ca/Article?contentid=861&language=English. Accessed July 22, 2021.
Tethered spinal cord. Pediatric Neurosurgery website. Available at: https://pediatricneurosurgery.org/diagnosis/tethered-spinal-cord. Accessed July 22, 2021.
Tethered cord syndrome. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/tethered-cord-syndrome. Accessed July 22, 2021.
Tethered spinal cord syndrome. American Association of Neurological Surgeons website. Available at: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Tethered-Spinal-Cord-Syndrome. Accessed July 22, 2021.
Last reviewed July 2021 by EBSCO Medical Review Board Rimas Lukas, MD Last Updated: 7/22/2021