Tethered Spinal Cord in Adults: Understanding a Rare Cause of Back and Leg Symptoms
Back pain and leg symptoms are extremely common. In most cases, they are caused by conditions such as disc degeneration, spinal stenosis, or nerve compression. However, in a small number of patients, symptoms may be linked to a condition known as a tethered spinal cord.
Although tethered cord syndrome is more commonly diagnosed in childhood, it can also be diagnosed in adults because it starts causing problems or it has been undiagnosed. Because symptoms may overlap with other spinal conditions, diagnosing tethered cord syndrome often requires careful clinical assessment alongside detailed spinal imaging.
As Mr Gordan Grahovac, Consultant Neurosurgeon and Complex Spinal Surgeon in London, explains:
"Tethered cord syndrome in adults is rare, but it can cause significant symptoms when the spinal cord becomes abnormally stretched or fixed. The key is identifying which patients truly have symptomatic tethering and which MRI findings are incidental."
What Is Tethered Cord Syndrome?
Tethered cord syndrome occurs when the spinal cord becomes abnormally attached within the spinal canal, preventing it from moving freely. Normally, the spinal cord shifts slightly as the body bends and stretches. When the cord becomes tethered, it experiences abnormal tension during movement.
This tension can affect nerve function and lead to symptoms such as leg pain, leg weakness, numbness, or bladder problems.
A tethered spinal cord may occur due to structures such as a thickened filum terminale, spinal lipoma, scar tissue around previous area that has been untethered, or congenital spinal abnormalities. Imaging sometimes shows a low lying conus medullaris, which refers to the lower end of the spinal cord sitting lower than usual on MRI.
However, a low lying conus medullaris does not always mean someone has tethered cord syndrome. Many people have this anatomical variation without symptoms, which is why MRI findings must always be interpreted alongside the patient’s symptoms and neurological examination.
Tethered Cord Syndrome in Children vs Adults
A tethered spinal cord is most commonly diagnosed in children, where it is usually linked to congenital spinal abnormalities such as spina bifida or a thickened filum terminale.
In childhood, as the child grows, this attachment can place increasing tension on the spinal cord, which may affect walking, bladder function, cause scoliosis, deformity of the foot, or leg strength. When identified early, tethered cord syndrome in children is often treated to prevent long-term neurological complications.
In adults, however, tethered cord syndrome is much less common. Some individuals may have had a mild congenital tethered spinal cord that only becomes symptomatic later in life. In other cases, tethering may develop due to scar tissue following spinal surgery or other spinal conditions.
Because symptoms of tethered spinal cord in adults overlap with more common spinal disorders, careful evaluation is required before confirming the diagnosis.
Symptoms of Adult Tethered Cord Syndrome
Symptoms of adult tethered cord syndrome often develop gradually and may vary between patients.
Possible adult tethered cord symptoms include:
Persistent lower back pain
Leg pain or weakness
Numbness or altered sensation in the legs
Reduced walking tolerance
Changes in bladder or bowel function
In some patients, symptoms may worsen with activity or prolonged standing due to tension placed on the spinal cord.
Low Lying Conus Medullaris on MRI: What It Means
Many patients first encounter the possibility of a tethered spinal cord after reading their MRI report, which may mention a low lying conus medullaris.
The conus medullaris is the lower end of the spinal cord. In most adults, it sits around the level of the first or second lumbar vertebra. When it appears lower on imaging, it may be described as a low lying conus.
Importantly, a low lying conus medullaris does not always mean someone has tethered cord syndrome. Some individuals have this anatomical variation without symptoms.
For this reason, specialists interpret MRI findings together with the patient’s clinical symptoms and neurological examination before making a diagnosis.
How Tethered Cord Syndrome Is Diagnosed
Diagnosis of tethered cord syndrome requires both imaging and clinical evaluation.
MRI scans of the spine help assess:
The position of the conus medullaris
Evidence of a low lying conus medullaris
Thickening of the filum terminale
Developing of spinal syrinx due to increased tension on the spinal cord
However, imaging findings alone are not enough to confirm tethered cord syndrome. Many people have incidental MRI findings that do not cause symptoms.
Specialists therefore consider the full clinical picture before diagnosing adult tethered cord syndrome.
Treatment Options for Tethered Cord Syndrome
Treatment for adult tethered cord syndrome depends on symptom severity and whether spinal cord tethering clearly explains the patient’s symptoms.
The majority of the patients may simply require monitoring and observation.
When symptoms strongly correlate with spinal cord tethering, treatment may involve tethered cord surgery, also known as detethering surgery or tethered cord release surgery.
The goal of tethered cord surgery is to release the structures anchoring the spinal cord, allowing it to move more freely within the spinal canal.
This procedure aims to:
Reduce spinal cord tension
Prevent neurological deterioration
Improve symptoms such as pain or weakness
When to Seek Specialist Advice
You may benefit from specialist review if you have:
Persistent back or leg symptoms without a clear explanation
MRI findings such as a low lying conus medullaris
Imaging showing a thickened filum terminale
Neurological symptoms affecting walking or bladder function
Most people with back pain do not have tethered cord syndrome, but specialist evaluation can help clarify whether imaging findings are clinically significant.
Specialist Care With Mr Gordan Grahovac
Mr Gordan Grahovac is a Consultant Neurosurgeon and Complex Spinal Surgeon with extensive experience diagnosing and treating complex spinal conditions, including tethered cord syndrome and adult tethered cord syndrome.
His approach combines:
detailed neurological assessment
careful interpretation of spinal imaging
consideration of both surgical and non-surgical treatment options
Working closely with specialist neuroradiologists and neurologists, Mr Grahovac ensures patients receive accurate diagnosis and personalised treatment planning.
If you have been told you may have a tethered spinal cord or MRI findings such as a low lying conus medullaris, specialist consultation can help clarify what these findings mean and whether treatment is necessary.
Frequently Asked Questions About Tethered Spinal Cords
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A low lying conus medullaris means the lower end of the spinal cord sits lower than usual on MRI imaging. In some cases it may be associated with tethered cord syndrome, but many people have this finding without symptoms.
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Yes. Although tethered cord syndrome is more commonly diagnosed in childhood, some patients develop symptoms later in life due to congenital tethering or scar tissue.
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No. A low lying conus does not automatically indicate tethered cord syndrome. Specialists interpret imaging alongside symptoms before making a diagnosis.
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Yes. Tethered cord syndrome in adults is uncommon, and most back pain or leg symptoms are caused by more common spinal conditions.
