Tethered cord syndrome is characterized by neurologic signs and symptoms secondary to abnormal tension on the spinal cord. This tension limits spinal cord mobility and results in progressive stretching and damage of the spinal cord. The majority of cases of tethered cord arise secondary to congenital abnormalities, such as spinal dysraphisms. Acquired causes include trauma, infection, or neoplasm. Traumatic causes of tethered cord may be related to major spinal trauma, minor indirect trauma (ie, pregnancy or childbirth), or prior surgery (often orthopedic or urologic).

Tethered cord can present in any age group. The clinical presentation and course depend on age of onset and underlying etiology:

• Newborns and young infants develop tethered cord secondary to spinal dysraphisms that are classified as either spina bifida aperta (ie, myelomeningocele) or spina bifida occulta (ie, dermal sinus). Cutaneous lesions (such as hair tufts, lipomas, or dimples) and orthopedic deformities may be present early on.
• Toddlers and children often develop signs of tethered cord secondary to spina bifida occulta that may have been previously undiagnosed or asymptomatic. They may present with gait changes secondary to progressive motor or sensory dysfunction. Over time, bladder and bowel dysfunction arises. Lower leg or back pain may occur.
• Adolescent and adult onset of tethered cord symptoms may be secondary to known spina bifida, trauma, or neoplasm. Scoliosis, pain, and bladder / bowel dysfunction are the most common symptoms.

Although tethered cord secondary to congenital anomalies may be asymptomatic for years, once symptoms do appear, without surgical intervention they tend to progress over time.