Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients Caregivers Providers
Log In Ask a Question
PubMed This is a summary of 23 peer-reviewed journal articles Updated
Neurosurgery · Tethered Cord Syndrome

What Are the Signs of Tethered Cord in Spina Bifida?

At a Glance

The most critical warning signs of tethered cord syndrome in children with spina bifida include unexplained changes in walking, new back or leg pain, and sudden regressions in bowel or bladder habits. Prompt evaluation by a neurosurgeon is essential to prevent permanent nerve damage.

In this answer

4 sections

01

Movement and Orthopedic Red Flags

02

Pain and Sensory Changes

03

Sudden Bladder and Bowel Setbacks

04

When to Contact Your Medical Team

For a child born with open spinal dysraphism (such as spina bifida), the spinal cord was repaired shortly after birth. As your child grows, scar tissue from that initial repair can cause the spinal cord to become stuck or “tethered” to the surrounding tissues [1][2]. When a growth spurt happens—particularly during the toddler years and early puberty—the attached spinal cord stretches, which can disrupt the nervous system [1][3].

The most critical warning signs of a tethering spinal cord include changes in how your child walks, new pain in the back or legs, sudden setbacks in bowel or bladder habits, numbness, or changes in foot shape [4][5][6]. These symptoms usually develop gradually over weeks or months, though sudden regressions can occur. Recognizing these red flags early is essential, as prompt evaluation by a neurosurgeon gives your child the best chance to halt the progression and protect their nerve function [7][8][2].

Movement and Orthopedic Red Flags

Because the nerves at the base of the spine control the legs and feet, a stretching spinal cord often shows up in how your child moves and stands. Watch for these physical signs:

  • Changes in walking (gait): You might notice your child tripping more often, dragging a foot, or walking with a new limp [4][5]. Tip: If you notice intermittent changes in how your child walks, take a short video on your phone to show your medical team.
  • Progressive weakness: Your child might lose strength in their legs or struggle with physical activities they used to do easily [4][9].
  • Changes in muscle tone: You may notice increased stiffness, tightness, or spasms (spasticity) in the legs [4][5].
  • Foot shape changes: Muscle imbalances caused by nerve stretching can physically pull the foot out of alignment, leading to foot deformities such as the return or worsening of clubfoot [6][10][11].
  • Progressive scoliosis: An unexplained or rapidly worsening curve in the spine can also be a physical sign of tension on the spinal cord [6][10][11].

Pain and Sensory Changes

Children with a tethered cord often experience distinct types of pain and changes in sensation [4][12][9]. Because children may not always have the vocabulary to describe nerve pain, pay attention if they complain of:

  • New back or leg pain: This often feels like a shooting, sharp pain down the legs, particularly during physical activity or when bending [4][12][9].
  • Numbness or tingling: Also known as somatosensory symptoms, this describes a “pins and needles” feeling or a loss of normal feeling in the legs, feet, or saddle area [4][5][6].
  • Perineal pain: Pain or heightened sensitivity in the perineum (the area between the genitals and the anus) is a very specific symptom of spinal cord tethering [13].

Sudden Bladder and Bowel Setbacks

While many children with spina bifida already have some baseline differences in bathroom habits, a change from their normal baseline is a primary indicator of tethering [4][14]. In fact, urological deterioration is often one of the earliest and most sensitive signs that the cord is under tension [15][16][17].

  • More frequent accidents: A new onset of daytime urinary or fecal incontinence [4][18][17].
  • Recurrent UTIs: An increase in urinary tract infections can signal that the bladder is no longer emptying properly due to nerve signals changing [4][18][17].
  • Changes in urinary urgency: Needing to rush to the bathroom more often or struggling to go.

Note: Your medical team will often monitor these changes using urodynamic studies (tests that measure how well the bladder and urethra store and release urine). These tests can detect subtle bladder pressure changes before obvious accidents start happening [18][19].

When to Contact Your Medical Team

You do not need to see all of these symptoms to reach out to your child’s doctor. Even a single persistent red flag—like a change in walking or a sudden regression in potty training—is enough reason to contact your neurosurgeon.

Important Overlap with Shunt Issues: For children with spina bifida who also have a ventricular shunt, it is critical to know that some of these symptoms (like gait changes, weakness, and bathroom accidents) can also be signs of a malfunctioning shunt or an active Chiari II malformation. Because a shunt malfunction is a life-threatening medical emergency, you should have your child evaluated immediately to rule it out.

When you call your neurosurgeon about potential tethering, they will likely start by ordering a physical exam, an MRI of the spine to visualize the tethering, and urodynamic testing [19][20][21][22]. If the cord is tethered and causing symptoms, surgical intervention (surgical detethering) involves gently freeing the spinal cord from the scar tissue. This is the standard approach to stop the progression of neurological and urological damage [23][8][4]. Because children continue to grow, it is possible for the cord to re-tether later in life, making lifelong monitoring an important part of your child’s care.

Common questions in this guide

What are the first signs of a tethered spinal cord?
Early warning signs often include changes in how your child walks, such as a new limp or tripping, along with sudden setbacks in bowel or bladder habits. You might also notice new back or leg pain or an increase in stiffness.
Can a tethered cord cause sudden bladder problems?
Yes, urological changes are often one of the earliest and most sensitive signs of a tethered cord. This can manifest as more frequent accidents, recurrent urinary tract infections, or a sudden change from your child's normal bathroom baseline.
How does a doctor test for tethered cord syndrome?
Your neurosurgeon will typically start with a physical exam and an MRI of the spine to visualize the tethering. They may also order urodynamic testing to check for subtle pressure changes in bladder function before obvious accidents start occurring.
What is the treatment for a tethered spinal cord?
If the tethered cord is causing symptoms, the standard treatment is a surgery called surgical detethering. During this procedure, a neurosurgeon gently frees the spinal cord from the scar tissue to stop the progression of neurological and urological damage.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Should we establish a 'baseline' with urodynamic testing now, even if my child isn't showing symptoms of tethering?
  2. 2.What specific changes in my child's current baseline leg strength or bowel/bladder function should prompt an immediate call to your office?
  3. 3.How often do you recommend routine screening or check-ins for tethered cord during my child's rapid-growth years, like the toddler stage or puberty?
  4. 4.If we notice potential symptoms like gait changes or weakness, how do we quickly differentiate between a sub-acute tethered cord issue and an emergent shunt malfunction?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

How to Achieve Social Continence in Spina BifidaWill My Child With OSD Have Trouble Learning in School?How to Cope With a Prenatal Spina Bifida DiagnosisDoes Open Fetal Surgery Affect Future Pregnancies?Do I Need a C-Section for a Baby With Spina Bifida?Can You Live Independently with Open Spina Bifida?What to Ask Your Fetal Surgeon About Spina Bifida RepairVP Shunt vs ETV/CPC for Hydrocephalus: Which is Better?What Disqualifies You From MMC Fetal Surgery?What Are Lemon & Banana Signs on Fetal Ultrasound?Open Spinal Dysraphism vs. Closed Spina BifidaWhat Records to Bring to a Fetal Spina Bifida Consult?Will My Child With Spina Bifida Be Able To Walk?

References

References (23)
  1. 1

    Diagnosis and Treatment of Tethered Spinal Cord: A Systematic Review.

    Hsieh P, Apaydin E, Briggs RG, et al.

    Pediatrics 2024; (154(5)) doi:10.1542/peds.2024-068270.

    PMID: 39449659
  2. 2

    Novel Concepts in Spine Pathophysiology.

    Theodore N

    Spine 2016; (41 Suppl 7()):S25-6 doi:10.1097/BRS.0000000000001433.

    PMID: 27015066
  3. 3

    Tethered Cord Syndrome After Myelomeningocele Repair: A Literature Update.

    Ferreira Furtado LM, Da Costa Val Filho JA, Dantas F, Moura de Sousa C

    Cureus 2020; (12(10)):e10949 doi:10.7759/cureus.10949.

    PMID: 33072445
  4. 4

    Surgical Treatment of Tethered Cord Syndrome in Adults: A Systematic Review and Meta-Analysis.

    O'Connor KP, Smitherman AD, Milton CK, et al.

    World neurosurgery 2020; (137()):e221-e241 doi:10.1016/j.wneu.2020.01.131.

    PMID: 32001403
  5. 5

    A rare case of thoracic lipomyelomeningocele in a young female: A case report.

    Sharma S, Khadka H, Aryal S

    Radiology case reports 2023; (18(3)):1372-1375 doi:10.1016/j.radcr.2022.10.042.

    PMID: 36819002
  6. 6

    Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery.

    Dulfer SE, Drost G, Lange F, et al.

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2017; (33(11)):1985-1995 doi:10.1007/s00381-017-3478-y.

    PMID: 28676974
  7. 7

    Management of split cord malformation and tethered cord syndrome: Experience of a main referral center in Uzbekistan.

    Akhmediev M, Alikhodjaeva G, Usmankhanov O, et al.

    Clinical neurology and neurosurgery 2024; (245()):108510 doi:10.1016/j.clineuro.2024.108510.

    PMID: 39154537
  8. 8

    Course of Urological Problems in Children with Spinal Dysraphism: Long-Term Follow-Up Results.

    Solakhan M, Oktay K, Guzel E, et al.

    Pediatric neurosurgery 2020; (55(2)):101-105 doi:10.1159/000509053.

    PMID: 32683366
  9. 9

    Lumbar spinal stenosis in a patient with complex spinal dysraphism caused by a supplementary midline muscle: A case report.

    Hermans SMM, van Aalst J, Beckervordersandforth J, van der Vlis TAMB

    Surgical neurology international 2022; (13()):121 doi:10.25259/SNI_85_2022.

    PMID: 35509578
  10. 10

    Russell-Silver syndrome associated with low conus medullaris.

    Gabor L, Canaz H, Canaz G, et al.

    Journal of pediatric neurosciences 2016; (11(4)):361-363 doi:10.4103/1817-1745.199482.

    PMID: 28217167
  11. 11

    Treatment of an anterior cervicothoracic myelomeningocele together with spine deformity correction in a child: illustrative case.

    Jackson HN, Laxpati N, Bauer DF

    Journal of neurosurgery. Case lessons 2024; (7(10)).

    PMID: 38437675
  12. 12

    Atypical presentation of tight filum terminale with thoracic disc herniation: a case report.

    Miyagami T, Nojiri H, Okada S, et al.

    Journal of medical case reports 2024; (18(1)):69 doi:10.1186/s13256-024-04371-z.

    PMID: 38310287
  13. 13

    Perineal pain secondary to tethered cord syndrome: retrospective review of single institution experience.

    Robbins JW, Lundy PA, Gard AP, Puccioni MJ

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2015; (31(11)):2141-4 doi:10.1007/s00381-015-2879-z.

    PMID: 26280630
  14. 14

    Late diagnosis of dorsolumbar lipomyelomeningocele with tethered cord in a middle aged adult: A case report from Nepal.

    Aryal S, Poudel S, Sharma S, Deo S

    Radiology case reports 2022; (17(12)):4532-4536 doi:10.1016/j.radcr.2022.08.064.

    PMID: 36189164
  15. 15

    Effect of early tethered cord release on urodynamic findings and lower urinary tract function in myelomeningocele patients.

    Ozaki D, Kimiwada T, Hayashi T, et al.

    Journal of neurosurgery. Pediatrics 2025; (35(2)):137-143 doi:10.3171/2024.8.PEDS24173.

    PMID: 39486060
  16. 16

    Clinical and urodynamic features of secondary tethered cord syndrome: How can they be found longitudinally?

    Lee SB, Im YJ, Jung JH, et al.

    Neurourology and urodynamics 2022; (41(1)):365-374 doi:10.1002/nau.24832.

    PMID: 34783385
  17. 17

    Urological Aspects of Spinal Dysraphism.

    Park K

    Advances and technical standards in neurosurgery 2023; (47()):273-289 doi:10.1007/978-3-031-34981-2_10.

    PMID: 37640879
  18. 18

    [TETHERED CORD SYNDROME IN CHILDREN WITH DAYTIME INCONTINENCE].

    Morizawa Y, Satoh H, Sato A, et al.

    Nihon Hinyokika Gakkai zasshi. The japanese journal of urology 2021; (112(4)):168-172 doi:10.5980/jpnjurol.112.168.

    PMID: 36261345
  19. 19

    Risk of occult spinal dysraphism based on lumbosacral cutaneous manifestations.

    Shields LB, Mutchnick IS, Daniels MW, et al.

    SAGE open medicine 2021; (9()):20503121211037172 doi:10.1177/20503121211037172.

    PMID: 34394932
  20. 20

    Ultrasonography and magnetic resonance imaging evaluation of pediatric spinal anomalies.

    Dhingani DD, Boruah DK, Dutta HK, Gogoi RK

    Journal of pediatric neurosciences 2016; (11(3)):206-212 doi:10.4103/1817-1745.193374.

    PMID: 27857788
  21. 21

    Use of ultrasound to estimate the prevalence of occult spinal dysraphism in children undergoing urogenital and anorectal surgeries: A cross-sectional study.

    Toms AS, Rai E, John NC, Panwar J

    Journal of anaesthesiology, clinical pharmacology 2024; (40(1)):90-94 doi:10.4103/joacp.joacp_254_22.

    PMID: 38666156
  22. 22

    Determining the optimal timing of screening spinal cord ultrasonography to detect filum terminale lipoma in infants.

    Albakheet SS, Yoon H, Lee MJ, et al.

    Ultrasonography (Seoul, Korea) 2020; (39(4)):367-375 doi:10.14366/usg.19061.

    PMID: 32962332
  23. 23

    Surgical treatment of tethered cord syndrome showed promising outcome in young children with short duration.

    Liu M, Deng W, Lu YY, et al.

    European review for medical and pharmacological sciences 2023; (27(5)):1831-1836 doi:10.26355/eurrev_202303_31545.

    PMID: 36930477

This page explains the warning signs of tethered cord syndrome for educational purposes only. Always consult your child's neurosurgeon or medical team for proper evaluation and medical advice.

Get notified when new evidence is published on Open spinal dysraphism.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.