What is this disease?

• The spinal cord normally floats free inside the spinal canal. However, sometimes, because of  reasons like meningomyelocele  surgery , spinal cord is pulled down and stuck, or fixed, to the lower part of spinal canal. Because of this, it stretches like a rubber band as a child grows. This can cause lasting damage to the spinal nerves. The common causes of this condition are birth defects called spina bifida. It includes conditions like myelomeningoceles or lipomyelomeningoceles, tethered  filum terminale, dermal sinus tract, diastematomyelia or diplomyelia.

How it is diagnosed?

• Tethered cord is diagnosed based on clinical and radiological findings. The common symptoms in children include Back pain or shooting pain in the legs, Weakness, numbness or problems with muscle function in the legs, Tremors or spasms in the leg muscles, Changes in the way the feet look, like higher arches or curled toes, Loss of bladder or bowel control that gets worse, Scoliosis or abnormal curve of the spine that changes or gets worse ,Repeated bladder infections or In a child with an unknown tethered cord, signs on the back such as a fatty mass, dimple, birthmark, tuft of hair or anorectal malformations. Its diagnosis is confirmed on MRI Spine . These children also need assessment by USG of urinary tract and Urodynamic studies.

How it is treated?

• Treatment is by surgery known as Laminectomy and detethering of spinal cord.

When it should be operated?

• As Spina Bifida is a birth defect, not a degenerative disease, any deterioriation in child during follow up n an indication for surgery. Deterioration almost always has a treatable cause. Early detection of deterioration offers the best chance for recovery and limits the deficit. Average age for detethering in major study was 7 years.

Are there other alternative methods of treatment?

• Surgery is only modality available.

What all I need to know before my child surgery?

• Read “All you need to know before your child's surgery” information booklet in website.

How is the surgery done?

• Surgery involves laminectomy, opening of duramater and separating the tethered cord from dura. The dura is again closed. It is commonly done under magnification of an operating microscope and neurological monitoring.

Remarks

• For more details of surgery, contact your surgeon

Related Photographs and videos

• Few photographs of steps done by me  is given here for learning purposes