Recovery after tethered cord surgery

Tethered cord is a relatively common spinal disease. As we all know, the spine plays a very important role in the function of the human body. If there is a health problem of tethered spinal cord, it may cause the patient to experience skin changes in the lumbar sacral region, movement and sensory disorders in the lower limbs, and urinary and bowel dysfunction. This disease can be repaired through surgery. Below, we will introduce you to the relevant knowledge about tethered cord in detail!

1. Causes of the disease

The spinal cord is located in the spinal canal. During the growth and development of a person, the growth rate of the spinal canal is greater than that of the spinal cord. Therefore, the lower end of the spinal cord gradually rises relative to the lower end of the spinal canal. Various congenital developmental abnormalities of the spinal cord and the end of the spine can lead to tethered cord, such as occult spina bifida, meningocele, myelomeningocele, tense filum terminale, lumbar intraspinal lipoma, congenital cyst and latent pilonidal sinus. In addition to the various congenital factors mentioned above, adhesions after lumbar meningocele surgery can also lead to spinal cord re-tethering. It is generally believed that tethered cord causes blood circulation disorders at the end of the spinal cord, leading to corresponding neurological symptoms.

2. Clinical manifestations

Changes in the skin of the lumbar and sacral region: bulges or depressions in the skin of the lumbar and sacral region, which may be accompanied by secretions or infection; excessive hair growth; occult spina bifida, pilonidal sinus, meningocele, subcutaneous lipoma, etc.

Kyphosis or scoliosis deformity: forked vertebrae, hemivertebrae and vertebral fusion, etc.

Movement disorders of the lower limbs: manifested as abnormal walking, weakness of the lower limbs, and ankle deformity (clubfoot).

Sensory disturbance of the lower limbs: manifested as paresthesia and pain in the lower limbs, perineum and lower back.

Bowel and bladder dysfunction: Common manifestations include urine retention, dysuria, urinary incontinence, frequent urination, less urination than normal, etc.; a small number of patients have constipation, or incontinence.

3. Disease Treatment

Surgery is the treatment of choice, and its goal is to release the tethered spinal cord.

If only the filum terminale is thickened and shortened, segmental lumbar laminectomy is required, and the filum terminale needs to be exposed, identified, and then cut off;

If there is a lipoma, it can be removed together with the filum terminale if it is easy to separate from the nerve tissue.

When performing surgery on patients, the minimally invasive concept should be implemented, microsurgery should be performed, and neuroelectrophysiological monitoring should be performed when necessary to loosen the tether as thoroughly as possible, avoid nerve damage, reduce re-adhesion and tethering, and prevent postoperative wound complications. Follow up the patients after surgery and provide the best possible guidance on the prevention and treatment of urinary system dysfunction, rehabilitation of lower limb movement and sensation, and correction of lower limb deformities. We believe that focusing solely on tethering surgery without providing proper guidance for continued diagnosis and treatment of these dysfunctions is detrimental to patients. It is a common pathological form of several lumbar occult spina bifida, and it is also the main pathophysiological mechanism of neurological damage caused by spina bifida.