Adult Tethered Cord is characterized by a spinal cord that is located at an abnormally low position within the spinal canal. The position in which it comes to rest in an adult (L1 or L2) is caused by the growth of the individual. Tethered cord results when the spinal cord cannot normally ascend with growth, which causes it to stretch or become damaged.
This condition presents differently, and sometimes less obviously, in adults than in children. For example, children experience difficulty walking, and adults usually have pain and weakness in the legs, back, and foot arches. Adult symptoms also include limb muscle atrophy, sensory deficit (numbness), and urinary frequency and urgency accompanied by a sense of incomplete emptying and even incontinence. In adults, symptoms are aggravated by trauma, maneuvers associated with stretching of the spine (flexion), disc herniation, and spinal stenosis.
Adult tethered cord is determined by an MRI, which shows a low level of the conus medullaris (below L2) and thickened filum terminale.
How tethered cord is treated is based on the underlying cause. If the only abnormality is a thickened, shortened filum, then a limited lumbo-sacral laminectomy with division of the filum may be sufficient to relieve the symptoms.
