The Clinical Triad of Occult Tethered Cord Syndrome


Tethered cord syndrome (TCS) is classically diagnosed by lumbar MRI. Patients with clinical symptoms suggestive of TCS with non-diagnostic radiological findings are designated as having “occult tethered cord syndrome” (OTCS). OTCS patients frequently demonstrate a triad of symptoms: urinary/bowel, neurological, and orthopedic.


This single-center study reviewed the clinical symptoms of a series of 92 patients with OTCS (24% male, mean age = 26, median age = 24, age range = 0 – 58) who underwent detethering procedures between 2011 and 2017. Symptom prevalence was assessed pre-operatively, within 120 days post-operatively, and after 120 days post-operatively to assess the 3 most common symptoms within each component of the triad. Comprehensive MRI examinations did not meet classical diagnostic criteria in any of the cases. The decision to pursue surgery was based on a combination of clinical examination, imaging, and urodynamic testing (positive findings in 77% of patients).


The most prevalent urinary/bowel symptoms were urinary incontinence (60%), constipation (33%), and increased frequency (30%). The most prevalent neurological symptoms were lower extremity pain (83%), lower extremity weakness (70%), and decreased sensation (51%). The most prevalent orthopedic symptoms were back pain (65%), foot deviation (32%), and neck pain (30%). All the above symptoms were significantly (α = 0.05) improved both within 120 days post-operatively and after 120 days post-operatively. 78 patients (85%) demonstrated all elements of the triad, 10 patients (11%) had 2 out of 3 elements, 2 patients (2%) had only 1 of 3 elements, and 2 patients (2%) had none of the elements.


Our study illustrates the most common findings within the symptom-triad of OTCS and the significant improvement in these symptoms following surgical intervention both in the shortterm and long-term. Further prospective study of the predictive accuracy of this triad to facilitate the diagnosis and surgical indication in OTCS is forthcoming.