Tethered cord
Alerts and Notices
Synopsis
Tethered cord can present in any age group. The clinical presentation and course depend on age of onset and underlying etiology:
- Newborns and young infants develop tethered cord secondary to spinal dysraphisms that are classified as either spina bifida aperta (ie, myelomeningocele) or spina bifida occulta (ie, dermal sinus). Cutaneous lesions (such as hair tufts, lipomas, or dimples) and orthopedic deformities may be present early on.
- Toddlers and children often develop signs of tethered cord secondary to spina bifida occulta that may have been previously undiagnosed or asymptomatic. They may present with gait changes secondary to progressive motor or sensory dysfunction. Over time, bladder and bowel dysfunction arises. Lower leg or back pain may occur.
- Adolescent and adult onset of tethered cord symptoms may be secondary to known spina bifida, trauma, or neoplasm. Scoliosis, pain, and bladder / bowel dysfunction are the most common symptoms.
Codes
ICD10CM:Q06.8 – Other specified congenital malformations of spinal cord
SNOMEDCT:
70534000 – Occult spinal dysraphism sequence
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Spinal disk herniation
- Cauda equina syndrome
- Spinal stenosis
- Multiple sclerosis
- Hereditary spastic paraplegia
- Spinal cord arteriovenous malformation
- Spinal cord neoplasm (see spinal cord compression)
- Syringomyelia – may be associated with the tethered cord or be present separately
- Arachnoiditis
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Management Pearls
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Therapy
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References
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Last Reviewed:04/30/2019
Last Updated:04/11/2022
Last Updated:04/11/2022