Symptoms of Pediatric Tethered Cord Syndrome: What Parents Need to Know

Understanding Tethered Cord Syndrome in Children

Tethered cord syndrome (TCS) is a neurological condition that primarily affects children and occurs when the spinal cord becomes abnormally attached to surrounding tissues. This restricts its movement within the spinal canal, potentially leading to progressive nerve damage. Early detection is crucial for preventing long-term complications, and while some signs are visible at birth, others may develop gradually over time.

Visible Physical Indicators on the Skin

In many cases, pediatric tethered cord syndrome presents with clear external markers that can be identified during a routine physical examination. Infants may have spina bifida with myelomeningocele, where a portion of the spinal cord and meninges protrude through an opening in the spine, forming a noticeable sac or lump on the back.

Other common skin abnormalities include dermal sinuses (small pits or tracts near the lower back), skin tags, excessive hair growth (hypertrichosis) in the lumbar region, and cutaneous dimples above the buttocks. These dermatological clues often serve as early warning signs and should prompt further diagnostic evaluation by a pediatric neurologist or specialist.

Hidden Cases: When Symptoms Are Not Obvious

Some children suffer from occult or hidden forms of spinal dysraphism, where no obvious external deformities are present. In these cases, symptoms may go unnoticed in infancy and only emerge as the child grows. One of the most telling signs involves dysfunction of the bladder and bowel.

Frequent urinary incontinence, difficulty initiating urination, chronic constipation, or recurrent urinary tract infections (UTIs) can all point to underlying neurological issues related to tethered cord syndrome. These urological problems are often misdiagnosed initially, which delays proper treatment.

Neurological and Musculoskeletal Complications

As the condition progresses, more serious neurological deficits may appear. Many affected children develop motor and sensory impairments in the lower limbs. This might manifest as muscle weakness, reduced reflexes, abnormal gait, or even difficulty walking.

Sensory loss—such as numbness or decreased sensation in the legs and feet—is also common. Over time, poor nerve signaling can lead to neurotrophic changes, including thinning of the skin, poor wound healing, and in severe cases, the development of pressure sores or chronic skin ulcers, particularly around the feet or lower back.

Why Early Diagnosis Matters

Early diagnosis through imaging studies like MRI scans allows for timely surgical intervention, which can prevent irreversible damage. Parents should be vigilant if their child shows any combination of developmental delays, unexplained leg pain, foot deformities (like clubfoot), or persistent toileting issues beyond typical toddler age.

Recognizing the subtle and not-so-subtle signs of tethered cord syndrome enables healthcare providers to intervene sooner, improving long-term outcomes and quality of life for affected children.