Tethered cord or tethered cord syndrome (TCS) refers to a neurological disorder in which the spinal cord is pathologically fixed and therefore under chronic tension. The result is progressive neurological deficits, pain, and bladder and bowel dysfunction. The term was coined by Hoffman[^2] and later by Yamada[^1]. What is decisive here is not only the anatomical anomaly, but 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 adhesions of the arachnoid can also lead to a tethered cord.
Secondary
Secondary causes can include a previous trauma or tumors, for example.
Treatment
Surgical untethering
The standard treatment is surgical release of the tethering, which is referred to as untethering[^1].
Prognosis
The prognosis depends essentially on three factors:
Patients diagnosed early usually benefit significantly from untethering. By contrast, longstanding deficits, especially severe neurogenic bladder dysfunction or pronounced muscle atrophy, often regress only incompletely[^1].