Tethered cord, or tethered cord syndrome (TCS), refers to a neurological disorder in which the Spinal cord is pathologically fixed and therefore subjected to chronic tension. This results in progressive neurological deficits, pain, and bladder and bowel dysfunction. The term was coined by Hoffman[^2] and later by Yamada[^1]. The decisive factor is not solely the anatomical anomaly, but rather the resulting functional impairment of the lumbosacral spinal cord.
Causes
Primary
A tethered cord can result from congenital malformations of the spinal cord, such as myelomeningocele, lipomyelomeningocele, or a spinal lipoma. Thickening of the Filum terminale or arachnoid adhesions can also lead to a tethered cord.
Secondary
Secondary causes may include, for example, a history of trauma or tumors.
Treatment
Surgical untethering
The standard treatment is surgical release of the tethering, known as untethering[^1].
Prognosis
The prognosis depends primarily on three factors:
Duration of symptoms
Extent of the neurological deficits
Age at diagnosis
Patients diagnosed early usually benefit substantially from untethering. Long-standing deficits, particularly severe neurogenic bladder dysfunction or pronounced muscle atrophy, often resolve only incompletely[^1].