Tethered cord syndrome is a condition in which the spinal cord is abnormally attached to surrounding tissues, creating tension that can affect neurologic function over time. It may be congenital or acquired and can present with a range of symptoms depending on the degree of cord involvement.
Aqib Zehri, MD, is a fellowship-trained neurosurgeon specializing in complex spinal cord conditions. He performs detailed evaluation of suspected tethered cord and develops individualized treatment strategies based on imaging findings, neurologic symptoms, and overall clinical context.
The spinal cord is designed to move freely within the spinal canal as the body bends and stretches. Tethered cord syndrome occurs when the spinal cord becomes abnormally attached to surrounding tissue, restricting its movement and placing tension on the cord.
This tension can interfere with normal nerve function and may lead to progressive neurologic symptoms. Tethered cord can be present from birth due to congenital abnormalities or develop later in life as a result of prior surgery, trauma, or spinal tumors.
Symptoms vary depending on age, severity, and duration of tethering. Because symptoms often develop gradually, they may be mistaken for other spine conditions.
Common symptoms include:
Back or leg pain, often worsened with activity
Weakness or numbness in the lower extremities
Changes in gait or coordination
Bladder or bowel dysfunction
In children, additional signs may include:
Skin changes over the lower spine (dimple, hair patch, or birthmark)
Foot deformities
Scoliosis or abnormal spinal development
Because symptoms can overlap with other conditions, imaging is necessary to confirm whether the spinal cord is tethered.
Tethered cord syndrome can present differently depending on when it is identified.
In children:
Often associated with congenital spinal abnormalities
May be detected early due to visible skin findings or developmental changes
Early treatment is often performed to prevent progression
In adults:
Symptoms may develop gradually over time
Often present with pain, weakness, or bladder dysfunction
May be associated with prior spine surgery, trauma, or undiagnosed congenital tethering
Understanding these differences is important in determining the timing and approach to treatment.
Diagnosis involves a detailed clinical evaluation and imaging of the spine.
Evaluation may include:
Neurologic examination assessing strength, sensation, and coordination
Review of symptom progression and functional changes
MRI to visualize the spinal cord and identify tethering
The goal is to determine whether the spinal cord is restricted and whether symptoms correlate with imaging findings.
Surgical treatment is considered when there is evidence that tethering is causing neurologic symptoms or functional decline.
Surgery may be recommended when there is:
Progressive weakness or sensory changes
Worsening bladder or bowel dysfunction
Pain that correlates with cord tethering
Imaging findings consistent with tethered cord and clinical symptoms
In some cases, observation may be appropriate if symptoms are mild and stable. The decision to proceed with surgery is based on symptom progression, neurologic findings, and overall clinical context.
The primary surgical treatment is release of the tethered spinal cord to reduce tension and preserve neurologic function.
Surgical goals include:
Releasing the tethered tissue
Protecting surrounding neural structures
Preventing further neurologic deterioration
Tethered cord surgery requires careful microsurgical technique and detailed planning. Dr. Zehri takes an individualized approach based on anatomy, prior history, and symptom profile.
While surgery can stabilize or improve symptoms, outcomes depend on the severity and duration of neurologic involvement prior to treatment.
As with any spinal cord procedure, there are risks that should be carefully considered.
Potential risks include:
Cerebrospinal fluid leak
Infection
Nerve injury or neurologic deficit
Retethering over time
Because of these factors, careful patient selection and surgical planning are essential to achieving the best outcome.
If you are experiencing symptoms such as progressive weakness, changes in coordination, or bladder dysfunction, a comprehensive evaluation can help determine whether tethered cord syndrome is contributing to your condition.
Call the office or request an appointment online to get started.