Tethered Cord Syndrome

What is Tethered Cord Syndrome ?

Tethered Cord Syndrome (TCS) is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. Normally, the spinal cord floats freely within the cerebrospinal fluid inside the spinal canal. In TCS, these attachments (often at the base of the spine) prevent the spinal cord from moving freely, causing it to stretch and put tension on the nerves as the spine grows or moves. This tension can lead to nerve damage, pain, and a variety of neurological symptoms.

Causes of Tethered Cord Syndrome

TCS can be congenital (present at birth) or acquired (develop later in life).

Congenital Causes (most common):-
- Spina Bifida: TCS is very closely associated with spina bifida, particularly myelomeningocele, where the spinal cord fails to separate from the skin of the back during development.
- Thickened Filum Terminale: The filum terminale is a thin, fibrous strand at the very end of the spinal cord. If it is abnormally thick or tight, it can tether the cord. This is one of the most common causes of congenital TCS.
- Lipoma: A benign fatty growth (lipoma) can be attached to or within the spinal cord, causing tethering.
- Dermal Sinus Tract: A rare congenital defect where there is an abnormal connection (a dimple or small hole) from the skin to the spinal canal, which can lead to tethering or infection.
- Diastematomyelia (Split Spinal Cord): A condition where the spinal cord is split into two halves, often around a bony or fibrous septum, which can cause tethering.

Other congenital anomalies: Such as myelocystocele:-

Acquired Causes:-
- Scar Tissue from Spinal Surgery: Previous spinal surgeries, especially for conditions like spina bifida or spinal tumors, can lead to the formation of scar tissue that then tethers the spinal cord. This is a common cause in individuals who undergo multiple spinal procedures.
- Spinal Trauma/Injuries: Severe spinal injuries can result in scar tissue formation that binds to the spinal cord.
- Spinal Tumors: Growths in or around the spinal cord can cause tethering.
- Infection: Spinal infections can lead to adhesions and scarring that tether the cord.

Symptoms of Tethered Cord Syndrome

The symptoms of TCS vary widely depending on the age of onset, the severity of the tethering, and which nerves are most affected. Symptoms often worsen with growth spurts or increased physical activity.

In Infants and Children:-

Cutaneous Lesions on the Lower Back: These are often the earliest and most visible signs:
- Hairy patch (faun’s tail)
- Skin dimple or pit (especially if deep or off-midline)
- Skin discoloration or birthmark (e.g., hemangioma)
- Fatty lump (lipoma)
Orthopedic Deformities:
- Foot deformities: Clubfoot, high arch (pes cavus), curled toes, toe walking.
- Leg length discrepancy: One leg or foot appearing longer or larger than the other.
- Scoliosis: Abnormal curvature of the spine.
- Gait abnormalities: Difficulty walking, tripping, progressive weakness in the legs.
Neurological Deficits:
- Weakness or numbness in the legs or feet.
- Changes in muscle strength or tone.
- Pain: Lower back pain, often radiating to the legs. This pain may worsen with activity and improve with rest.
Bladder and Bowel Dysfunction:
Urinary incontinence or urgency: Can manifest as sudden onset of bedwetting after being toilet-trained.
Frequent urinary tract infections (UTIs).
Bowel dysfunction: Constipation or fecal incontinence.

In Adults:

Symptoms in adults are often more severe and typically develop slowly, usually due to decades of accumulated tension on the spinal cord.

Severe lower back pain: Often radiating to the legs, hips, or even the genital/rectal area. This pain can be exacerbated by bending, sitting cross-legged (“Buddha-sitting”), or holding weight (the “3-B sign”).
Progressive weakness and numbness: In the lower extremities, often leading to muscle atrophy.
Sensory disturbances: Numbness, tingling, or altered sensation, often in a patchy distribution.
Bladder and bowel dysfunction: Urinary retention, incontinence, or frequent UTIs; constipation or fecal incontinence.
Gait and balance problems: Increasing difficulty with walking, unsteadiness.
Foot deformities: Worsening or new onset of foot abnormalities.

Advanced Physiotherapy for Tethered Cord Syndrome

Physiotherapy plays a supportive but crucial role in managing Tethered Cord Syndrome, both pre-operatively (to manage symptoms and maintain function) and post-operatively (for rehabilitation after surgical untethering). It cannot cure the underlying anatomical tethering but aims to optimize function, manage symptoms, and prevent secondary complications.

Goals of Physiotherapy:-
- Pain management.
- Improvement of muscle strength and endurance.
- Enhancement of balance and coordination.
- Restoration of optimal gait patterns.
- Management of bladder/bowel dysfunction (in collaboration with urology).
- Prevention of joint contractures and deformities.
- Improvement of overall functional independence and quality of life.
- Gait analysis: Observe walking pattern for deviations, balance issues.
- Muscle strength and endurance testing.
- Range of motion assessment: Joints of the spine, hips, knees, ankles, and feet.
- Postural analysis.
- Functional outcome measures.
Pain Management:-
- Modalities: Heat or cold therapy, TENS (Transcutaneous Electrical Nerve Stimulation) for symptomatic pain relief.
- Posture and Body Mechanics Training: Teaching ergonomic principles and proper body mechanics to reduce strain on the back during daily activities.
Strengthening and Endurance:
- Core Stabilization: Exercises to strengthen deep abdominal and back muscles (e.g., transversus abdominis, multifidus) to improve spinal stability and support. This is crucial for overall function.
- Lower Extremity Strengthening: Targeted exercises for weakened muscle groups (quadriceps, hamstrings, hip abductors/adductors, ankle dorsiflexors/plantarflexors, foot intrinsics) using resistance bands, weights, or bodyweight.
Balance and Proprioception Training:
- Static Balance: Progressing from stable surfaces to unstable surfaces (foam pads, wobble boards, BOSU balls) in varying positions (sitting, standing, single-leg stance).
- Dynamic Balance: Walking heel-to-toe, walking on uneven surfaces, obstacle courses, agility drills (e.g., cone drills, ladder drills), multi-directional movements.
- Vestibular and Visual Integration: Exercises that challenge visual input (e.g., standing balance with eyes closed briefly, head turns during walking) and integrate vestibular function to improve overall balance strategies.
Gait Re-education:
- Analysis and Correction: Identifying specific gait deviations (e.g., foot drop, scissoring gait, toe walking) and implementing targeted exercises to correct them.
- Treadmill Training: With or without partial body weight support, to facilitate repetitive and normalized gait patterns.
- Flexibility and Range of Motion:
- Stretching: Gentle, sustained stretching for tight muscles (e.g., hamstrings, hip flexors, calf muscles) to prevent contractures and improve mobility.
Joint Mobilizations:
- Peripheral Joint Mobilizations: For joints that become stiff secondary to altered gait or disuse (e.g., ankle, knee, hip). Gentle, pain-free mobilizations (grades I-IV) can help restore joint play and overall range of motion.
Functional Training:
- Activities of Daily Living (ADL) training: Improving transfers, dressing, bathing, and other self-care activities.
- Community ambulation: Training for safe walking in various environments.
Bladder and Bowel Management:-
- Pelvic Floor Muscle Training: Exercises to strengthen or relax pelvic floor muscles under the guidance of a specialized physiotherapist (pelvic health PT).

BOOK AN APPOINTMENT

Working Hours

Mon - Sat: 9:00AM to 8:30PM
Sunday: 9:30AM to 7:30PM

Call Us

+91 8090080906
+91 8090080907
+91 8866991000