It is an odd thing but every now and then a news item will come out about a child with a “tail.” The “tail” often turns out to be a small benign tumor, called a lipoma, that has developed on the lower part of the child’s back. While this makes for a sensational story, these lipomas can actually be a sign of a very serious underlying spinal cord problem called Tethered Cord Syndrome (TCS).
Dr. Richard Anderson from the The Spine Hospital at the Neurological Institute of New York spoke about this syndrome at the AOSpine meeting to a group of neurosurgeons and orthopedic surgeons. He explained the causes, how to recognize the syndrome, and how it can be treated.
With TCS, a part of the spinal cord becomes attached or “tethered” to the surrounding spinal column. This is typically the result of abnormal fetal development but occasionally can be from scar tissue that develops after a Spinal Cord Injury.
Normally, as a child develops, their spinal cord grows vertically at a much slower rate than their spinal column. For this reason, the cord needs to be able to freely move in the canal. If it is not free, then the growing spine will pull on the cord. With increasing tension, the blood flow within the cord becomes restricted and parts of the cord can become permanently damaged.
This process can take a while, however, and a child may have no symptoms for a long time, sometimes not even until they are fully grown and her cord has been maximally stretched.
TCS is called a “syndrome” because it encompasses a whole host of signs and symptoms, none of which are present in every case. These can include neurological problems like loss of sensation or muscle control, muscle wasting, incontinence, and reflex changes. Sometimes the problems show up via devolopemental deformities like differing leg length, hip subluxation, foot deformities, or scoliosis. Sometimes, the only sign is disabling back pain.
Unfortunately, once these kinds of problems have developed, the spinal cord may have become permanently damaged. But, there are a couple of signs that may manifest early, before the cord is damaged.
Dr. Anderson says, “Luckily most of the conditions are picked up early due to unusual signs in the middle of their lower backs. These include fatty masses (lipomas), areas of increased pigmentation (hemangiomas), dimples or large collections of hair. When noticed, these skin signs should prompt an investigation which usually includes an MRI scan. During infancy an ultrasound may be performed to help identify one of these conditions.”
Dr. Anderson talks about the conditions of TCS as plural because the causes of TCS are varied. He explains, “There are a handful of problems that can cause TCS including, tight filum terminale, lipomeningomyelocele, split cord malformations, dermal sinus tracts , dermoids, and cystoceles. And, because the causes of the tethering vary, the treatment also varies.”
Certainly there are medications that are used to help treat the symptoms of this problem such as pain, and incontinence. However, Dr. Anderson explains there are a number of surgical procedures that can be done to halt any cord damage.
“The exact surgical technique is dependent on the original cause of the tethering,” says Dr. Anderson. “The surgery is designed to address the cause of the tethering and to relieve it to allow normal growth.”
What each procedure has in common is that by releasing the tethered cord, it can halt the progression of problems and often improves symptoms. Dr. Anderson says, “Children generally do well, particularly when it comes to pain control. Once a tethered cord is diagnosed, we generally recommend surgery as soon as possible to try to reverse current symptoms and prevent any permanent damage to the spinal cord”
For this reason, the best case scenario is when TCS is discovered early. The children who have outward signs on their backs like a patch of hair or discolored skin, or even what looks like a “tail” are the lucky ones. They can be treated early and have the potential for a completely normal life.
Originally posted Dec 12, 2012
Updated May 10, 2017