What Are the Treatments for Lumbar Tethered Spinal Cord?

Tethered spinal cord syndrome can be alleviated by surgery to the lumbar spine. This is generally performed in children because the maturing spinal column grows and stretches the spinal cord, and sometimes the spinal roots become irritated, resulting in painful sensations. Sometimes adults also require detethering when they exhibit similar signs and symptoms.
Surgical Detethering
According to the New York Presbyterian Hospital, early surgery is usually recommended for children showing signs of a tethered spinal cord, and this is the primary method used to repair this condition. Treatment will prevent deterioration of nerve function as the child's spine grows. The procedure necessitates exposing the lumbar vertebrae in the lower back where the spinal cord is tethered, or pinned. The surgeon will detether the spinal cord by excising any protrusions or removing adhesion points. This is very delicate surgery and the dangers of spinal cord or spinal nerve root injury are omnipresent. The nervous system is therefore monitored during surgery to minimize the chances of damage. However, even with these advanced techniques, the risk of complication of an atonic bladder has not proven to be diminished. Also, the complications of sexual and bowel dysfunctions may result. These conditions may be permanent or transient. If a child matures and reaches adult height without showing signs of tethered spinal cord syndrome, then treatment may not be necessary. However, there is no guarantee the patient will remain unaffected. With movement of the spine, the tethered spinal cord gradually begins to wear down and the patient may experience symptoms in adulthood; surgery may be indicated at that point.
Sometimes making a large incision on the back for open surgery to untether the spinal cord is not an option. Under these circumstances, the surgeon may opt to cut specific spinal nerve roots. This can ease the painful symptoms of tethered spinal cord syndrome. This procedure can be performed endoscopically. According to a 2009 paper in the journal "Child's Nervous System," such endoscopic untethering can be safe and effective. It has the advantages of reduced surgical trauma, postoperative pain and blood loss, as well as a smaller surgical incision and a shorter hospital stay. It is not known, however, if using endoscopic untethering techniques yields superior efficacy results.

Sometimes the spinal cord can retether after surgery, and this can happen months or years later. According to a 2006 article in the "Journal of Neurosurgery," in such circumstances another surgery may be required to untether the spinal cord once again. The incidence of retethering in children is significantly higher than in adults.