The tethered cord syndrome involves a variety of neurologic symptoms caused by a longitudinal traction on the conus of the distal spinal cord. It may occur in an infant with a congenital defect, or it may appear in an adolescent or adult.


The conus is considered abnormally low if it is at or below the L1-L2 disc space (Gupta, page 365).


Conditions associated with a tethered cord:

(1) neural tube defects

(1a) spinal dysraphism, which may be occult

(1b) diastematomyelia

(1c) lipomeningomyelocele

(2) lumbosacral lipoma (which may be a feature of occult spinal dysraphism)

(3) tight filum terminale

(4) fibrous adhesions

(5) neurenteric cyst

(6) dermal sinus tracts

(7) syringomyelia


Clinical findings:

(1) diffuse and non-dermatomal leg pain

(2) anorectal pain

(3) bladder dysfunction (frequency, urgency, stress incontinence, overflow incontinence)

(4) bowel dysfunction, including diarrhea

(5) in children, foot and spine deformities

(6) motor impairment of the lower extremities

(7) decreased sensation in the perineum and lower extremities


Symptoms may be precipitated by a sudden stretching of the conus associated with:

(1) trauma

(2) sexual intercourse

(3) child birth

(4) disc herniation

(5) lumbar spondylosis

(6) heavy lifting

(7) exercising

(8) prolonged sitting


To read more or access our algorithms and calculators, please log in or register.