Post-traumatic tethered spinal cord is a condition that can occur following spinal cord injury and can result in progressive deterioration of the spinal cord. Posttraumatic tethered spinal cord is a condition which occurs following injury to the spinal cord where scar tissue forms and tethers or holds the spinal cord to the soft tissue covering which surrounds it called the dura. This scar tissue prevents the normal flow of spinal fluid around the spinal cord and impedes the normal motion of the spinal cord. Myelomalacic (softening or increased water content) changes may then occur in the spinal cord. Tethering of the spinal cord has been suggested as a pathophysiological cause for the formation of cysts or syrinxs in the spinal cord. A posttraumatic tethered cord can occur without evidence of syringomyelia; however, in our experience, post-traumatic cystic or syrinx formation will not occur without some degree of tethering of the spinal cord. Posttraumatic tethered cords and syringomyelia are treated surgically when a complex of clinical symptoms occurs.
The clinical symptoms for tethered spinal cord may include: progressive loss of sensation or strength, hyperhidrosis (profuse sweating), spasticity, pain, autonomic dysreflexia (labile blood pressure), and/or Horner's syndrome (dilated pupil). Deterioration of the spinal cord related to these myelopathies can occur above and/or below the level of injury.
Sensory and motor symptoms are a result of changes occurring in the spinal cord, and are directly related to the specific location of these changes in the spinal cord. In other words, if changes occur above the level of injury preserved function is affected. Patients may experience a slow and progressive loss of the ability to feel hot or cold water on their skin or develop hypersensitivity, so that touching the skin causes pain. This change in sensation occurs in areas where the patient previously had normal or impaired sensation. Loss of strength can be described by patients as the inability to use certain muscles that were previously present and/or the development of fatiguing muscle groups which interferes with function. For instance, patients often say they have difficulty wheeling their chair the same distances or performing repetitive motions for the same amount of time.
Hyperhidrosis or profuse sweating can occur anywhere on the body and occurs without a specific cause. Patients can develop the new onset of spasticity, or spasticity can worsen, unrelated to other issues such as a plugged catheter, skin breakdown, or bowel program.
The onset of new pains or the worsening of pains that were present at the time of injury may occur. Secondary to these pains, patients report various types of symptoms, including burning, stinging, stabbing, sharp, shooting, electrical, crushing, squeezing, tight, vise-like cramping pains. These pains generally occur in areas where patients have lost sensation or where sensation sense is not normal.
Autonomic dysreflexia is described as an over-activity of the autonomic nervous system in response to stimuli. This can result in rapid swings in blood pressure, blotchy skin or goose bumps and sweating. These symptoms can be present unrelated to a stimulus or begin occurring at times when they had not before (i.e., bowel programs).
The Horner's syndrome usually presents as one pupil appearing smaller than the other pupil, and can switch from side to side. This symptom is not always present and can occur at the time of a spinal cord injury.
Surgical intervention for tethered spinal chord is an option when patients are experiencing progressive loss of sensory and/or motor function. If medical management of pain, spasticity, dysreflexia, and sweating has been unsuccessful, surgical intervention may be considered.
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