What are Prognosis Of Spinal Cord Injury

A tethered spinal cord can present the patient with neurological impairments that can vary widely, from barely recognizable to profoundly disabling. Usually the symptoms first appear in childhood where there is adequate time to perform surgery. Early surgical intervention has the best prognosis for symptomatic relief since it can correct neurological damage before it progresses.
A tethered spinal cord is an abnormal condition that causes tethered spinal cord syndrome. The syndrome occurs as a result of tissue attachments between the spinal cord and the inside of the spinal column. The spinal cord normally floats in fluid, but these attachments limit movement by pulling on the spinal cord from the base of the spinal canal. As the patient grows, the spinal cord stretches and deforms as the bones around the spinal cord elongate. This can result in significant neurological dysfunction.

The spinal cord can become tethered for many reasons. The most common reason is a result of birth defects called myelomeningoceles, lipomyelomeningoceles or split cord malformation, Columbia University Medical Center notes. As the child grows, the spinal cord cannot stretch properly, which places stresses on the spinal nerves. The first symptoms are pain and younger children will fail to develop function in the legs. Older children may lose leg, bladder and bowel function. These symptoms usually are associated with unusual signs on the lower back including fatty deposits, hyperpigmentation, dimples or clumps of hair growth. These symptoms generally prompt a thorough physical examination, diagnosis and ultimately the recommendation for surgery. The surgery aims to release the spinal cord from the adhesions at the level of involvement. The prognosis for a child surgically treated for tethered spinal cord syndrome is good but declines with age, according to the Columbia University Department of Neurological Surgery.
Tethered spinal cord syndrome in adults is uncommon. However, if a child’s spinal cord tethering is allowed to progress untreated into young adult life, then the symptoms may have progressed where neurological damage, at least in part, is permanent. Surgery to remove the adhesions is usually successful, but the neurological symptoms may not resolve as completely as in younger patients, according to a January 2001 article by B. Iskander in the journal "Neurosurgical Focus." Pain alleviation varies from patient to patient. Urinary and bowel function may not resolve fully, but the outcome usually is favorable. The risks of surgery increase with the patient’s age.

The most common serious complication of tethered spinal cord surgery is an atonic bladder. This occurs when roots are damaged during surgery. Despite intraoperative monitoring, the risk of this complication is not improved. Another risk is leakage of cerebrospinal fluid which can cause neurological damage. Other risks are common to general surgery and include blood clots, deep vein thrombosis, infection, bleeding and other neurological damage.