Abstract
The diagnosis of tethered cord syndrome (TCS) is based upon history and examination, confirmed in many cases—though not all—by MRI findings. In adults, back and leg pain (worse when walking up steps), weakness, sexual dysfunction, neurogenic bladder, or rectal incontinence are typically reported. In addition to decreased sensation and weakness of the legs, there is usually pain when raising the leg from a lying position (a positive stretch/traction sign), and often scoliosis, hammertoes, or pes cavus (high arch) foot deformity. Headache in the lower back of the head and hand numbness may occur as a remote effect of TCS. In children, the history may include toe walking, delayed walking, and involuntary urination. The diagnosis of TCS should be made with caution in the pediatric population, where urinary disorders are common.
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