The spinal cord is intended to move freely within the spinal canal. A tethered spinal cord or tethered cord occurs when the spinal cord is attached to tissue at the base of the spine. As a result, as children grow the cord cannot ascend and will stretch leading to pain and possible nerve damage. Tethered cord is common in children with spina bifida but can occur in children who do not have this as well.
Fortunately, it is a very treatable condition that requires your Neurosurgeon to cut or untether the adherent tissue freeing the cord and relieving the symptoms.
The symptom most identified in newborns is an unusual dimple, raised bump, discoloration or patch of hair on the lower back. Older children may complain of back pain, have weakness or numbness in the legs and feet, difficulty walking due to tightness (spasticity) in the legs, or loss of bladder and/or bowel control.
What to expect from you visit:
An MRI is the best way to visualize the spinal cord and diagnose a tethered cord. If your child recently had an MRI, it is helpful to bring that report and a disc of the imaging to your visit, so your Neurosurgeon can review the MRI and discuss the findings with you. If your child is having symptoms and an MRI confirms a tethered cord, surgery may be discussed at this visit as well.
What to expect from surgery:
Not all tethered spinal chords require surgery. However, if you and your surgeon decide that surgery is the best option for your child this is what to expect. Families will be given a date and time for surgery during their clinic appointment. It is standard that children do not have anything to eat past midnight on the day of surgery. We understand this is difficult for our very young patients and take special care to schedule those surgeries as early in the day as possible. It is important you bathe your child and wash their hair either the night before or the morning of surgery to help prevent post operative infections.
The day of surgery your surgeon will review everything discussed in the office and be sure to answer any questions caregivers or children have. The surgery generally requires 2-4 hours to complete and updates will be provided by our OR staff. There is some additional time required at the beginning of your child’s surgery while the anesthesia team places an IV and helps your child fall asleep.
After surgery your child will be sent to our wake up (PACU) area. After discussing the surgery with your Neurosurgeon you are welcome to rejoin them there. They will be monitored carefully as the anesthesia begins to wear off. From there they will be taken to the Neurosurgical floor for monitoring following the surgery.
There will be a 1-2 inch incision at the lower back and this can be painful. We are very proactive with pain control after surgery, but it is not possible to be completely pain free. Fortunately the pain often subsides by the second or third day. Following surgery we want to promote healing right away and one of the best ways to do this is to encourage your child to lay flat in bed for 72 hours following surgery. This takes the stress off the lower spine, prevents spinal fluid leaks, and promotes early wound healing.
After 72 hours flat children may begin to sit up and move around. Often, our friendly Physical Therapist will help as your child begins to sit up and take those first steps. Generally, kids do well quickly and are discharged home 4-6 days following surgery.
To care for the incision wash daily with a mild soap and gently pat dry. The incision will have small clear sutures that will dissolve on their own in approximately 10 days. Patients should avoid submerging the incision completely underwater for 14 days following surgery, so this means taking modified baths and no swimming in pools or lakes.
Caregivers and patients should monitor for any redness or swelling that occurs in the days or weeks following surgery. Rarely a superficial wound infection could occur and is easily treatable if detected early. Please notify the Neurosurgery department at (313)833-4490 of any redness, swelling, or drainage and one of Advance Practice Providers will provide you immediate guidance, and a same day appointment if necessary.
A scheduled “wound check” appointment will be made 10-14 days after surgery with one of our Advanced Practice Providers. This is a good time to talk about returning to school, day care, or other activities. This is another great opportunity to sit and answer any and all questions now that the stress of the hospital is behind you. In addition to the wound check, a scheduled follow up with your surgeon will be provided as well 4-6 weeks after surgery.