Tethered Cord Release

(Tethered Spinal Cord Release)

Definition

Tethered spinal cord is an abnormal attachment of the spinal cord to tissue around it. A tethered cord release is a procedure to separate the spinal cord from tissue that holds it in place. The exact steps will depend on individual needs.

Reasons for Procedure

The end of the spinal cord normally hangs and moves freely inside the vertebral column. Abnormal tissue, growth, tightening, or thickening of tissue can restrict movement of the spinal cord. This causes extra stress on the nerves which can cause a range of symptoms known as tethered cord syndrome.
A tethered cord release reduces or removes the tissue that is holding the spinal cord in place. Releasing the tether prevents further nerve damage from occurring. The procedure may relieve some of the current symptoms but some nerve damage may be permanent.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Bleeding
  • Infection
  • Repeat procedures if the spinal cord reattaches to tissue
  • Spinal cord damage, which may limit other functions
  • Problems with muscle strength, or bladder or bowel function

What to Expect

Prior to Procedure

The doctor may do the following before surgery:
  • Physical exam, including an evaluation of the spine and supporting structures
  • Blood tests
  • Urodynamic tests to assess urine flow and bladder muscle control
  • Imaging tests to evaluate internal structures of the lower back, such as:
In the time leading up to the procedure:
  • Arrange for a ride home.
  • Arrange for help at home.
  • Talk to your doctor about any allergies you have or medications you take. You may be advised to stop taking certain medications up to a week before the procedure.
  • Do not eat or drink anything after midnight before the day of surgery unless otherwise instructed.

Anesthesia

General anesthesia will be used. You will be asleep during the procedure.

Description of the Procedure

The exact steps of the procedure will depend on the tether and how much surrounding tissue is involved. Most will start with an incision in the low back. The incision will pass through muscle and protective layers of tissue around the spinal cord called meninges. Sometimes a portion of the bone will need to be removed. The size of the incision will depend on the amount of tissue involved and location of tether tissue. Some options include:
  • Cutting filum terminale, tissue that normally sits around spinal cord but can cause problems in some
  • Removal of fatty tissue, tumors, or scar tissue
The procedure with may be done with:
  • Scalpels
  • Surgical microscope
  • Laser
Once the spinal cord is free, the internal tissue layers and muscles are closed. If a bone segment was removed it may be reattached. The skin is closed with stitches or a waterproof bond. A bandage will be placed over the area.
Nerves to the legs and bladder will be monitored during surgery to look for any changes. This will help protect nerves from further damage.
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Immediately After Procedure

How Long Will It Take?

About 3 hours, but more complex procedures may take longer.

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. There will be some pain in the surgical area for the first few days but should fade as the area heals. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 4-7 days. If there are any complications, a longer stay may be needed.

Post-procedure Care

In the recovery room blood pressure, pulse, and breathing will be monitored. Recovery may also include:
  • Pain medications
  • Antibiotics to prevent infection
  • Monitoring nerve function, such as leg movement and urine control
  • Repositioning to prevent pressure sores for the first 72 hours after surgery
You will have to lie flat on your back for up to 72 hours after the surgery. This is to prevent cerebrospinal fluid (CSF) from leaking around the spinal cord. CSF is a fluid that surrounds and protects the brain and spinal cord.
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incision covered
There are also steps you can take to reduce your chances of infection, such as:
  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
Recovery time depends on overall health and the amount of surgery needed. Help will be needed at home for daily household tasks and to help care for surgical wounds.
It may take a few weeks to return to normal activity with a slow increase to normal activity. Additional rehabilitation, including physical and/or occupational therapy, may be needed. Therapy may help to recover lost function or teach how to adjust for nerve damage that did not improve with surgery.
In the recovery room blood pressure, pulse, and breathing will be monitored. Recovery may also include:

Call Your Doctor

  • It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge around the incision site
  • Clear fluid leaking from the incision site
  • Bulging under the incision site
  • Changes in bladder or bowel function
  • Numbness, tingling, or muscle weakness below the waist
  • Pain that cannot be controlled with the medications you’ve been given
  • New or worsening symptoms
If you think you have an emergency, call for emergency medical services right away.

RESOURCES

American Association of Neurological Surgeons http://www.aans.org

Healthy Children—American Academy of Pediatrics https://www.healthychildren.org

CANADIAN RESOURCES

Canadian Neurological Sciences Foundation http://www.cnsfederation.org

Caring for Kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

References

Bui CJ, Tubbs RS, et al. Tethered cord syndrome in children: A review. Neurosurg Focus. 2007;23(2):E2. Available at: http://thejns.org/doi/pdfplus/10.3171/FOC-07/08/E2. Accessed August 26, 2015.

Tethered cord. The Hospital for Sick Children About Kids Health website. Available at: http://www.aboutkidshealth.ca/En/HealthAZ/ConditionsandDiseases/BrainandNervousSystemDisorders/Pages/Tethered-Cord.aspx. Updated November 10, 2009. Accessed August 26, 2015.

Tethered spinal cord. Pediatric Neurosurgery website. Available at: http://pediatricneurosurgery.org/diagnosis/tethered-spinal-cord. Accessed August 26, 2015.

Tethered cord syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 12, 2014. Accessed August 26, 2015.

Tethered spinal cord syndrome. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Tethered%20Spinal%20Cord%20Syndrome.aspx. Updated July 2014. Accessed August 26, 2015.

Treatments for tethered spinal cord in children. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/conditions-and-treatments/conditions/t/tethered-spinal-cord/treatments. Accessed August 26, 2015.

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