TCSA Glossary of Terms

Adhesions: Bands of scar tissue that can form after surgery and sometimes stick tissues
together. In the spine, adhesions may contribute to retethering (the cord getting stuck again
after release).

Ankle Clonus: A rhythmic, involuntary pulsing movement of the foot when the ankle is quickly
flexed. It can be a sign of nerve involvement in some neurological conditions. Ask your provider
what it means in your case.

Bowel Dysfunction: Changes in bowel control, frequency, constipation, or accidents (soiling)
that may be related to nerve signals affected by tethered cord syndrome.

Cauda Equina: The bundle of nerve roots that extends below the end of the spinal cord
(conus). These nerves serve the legs, bowel, bladder, and sexual function. Tethering can affect
how well these nerves work.

Chiari Malformation: A condition where part of the cerebellum sits lower than usual, pushing
into the spinal canal. Chiari and tethered cord can occur together in some patients, and
symptoms may overlap (headaches, balance issues, etc.).

Clinical Diagnosis: A diagnosis made primarily from symptoms, history, and examination
findings, even when imaging is not definitive. This is important for occult tethered cord
discussions.

Conus Medullaris: The tapered end of the spinal cord. Its usual position in most people is
around the level of the first or second lumbar vertebra (L1–L2). When lower, it may suggest
tethering.

Detethering / Tethered Cord Release (TCR): Surgery to free the spinal cord so it can move
more normally. Often involves cutting or removing the filum terminale and may include releasing
other tethering structures.

Dermal Sinus Tract: A small, often hidden tube‑like tract from the skin surface (usually midline
lower back) down toward deeper tissues near the spine. This can be associated with spinal cord
tethering and carries a risk of infection.

Diastematomyelia / Split Cord Malformation: A congenital condition where the spinal cord is
split into two halves (partial or complete) by bone, cartilage, or fibrous tissue. This is often
associated with tethering and may require surgical treatment.

EMG (Electromyography): A test that measures how muscles respond to nerve stimulation. It
can help evaluate nerve function in patients with suspected tethered cord–related leg weakness
or changes.

Excessive Spinal Cord Tension: A descriptive term sometimes used by clinicians to explain
what’s happening in tethered cord: the cord cannot glide normally with growth or movement, so
it becomes stretched or tensioned, potentially damaging nerves over time.

Fatty Filum: A filum terminale that contains fat due to differences in tissue development before
birth. A fatty filum can act like a “tether” that restricts spinal cord motion and is a common
reason for surgical release.

Filum Terminale: A thin, thread‑like piece of tissue that anchors the bottom of the spinal cord to
the lower spine (sacrum). If thickened, tight, or fatty, it can contribute to tethering.

Gait Abnormalities: Noticeable differences in how a person walks—limping, toe‑walking,
in‑toeing, tripping, or uneven stride. These may reflect pain, weakness, or nerve changes linked
to tethered cord.

Hydromyelia / Syringomyelia (Syrinx): A fluid‑filled cavity within the spinal cord. In some
patients, tethering may contribute to fluid pressure changes that allow a syrinx to form.
Treatment decisions depend on symptoms, size, and cause.

Incontinence: Loss of bladder or bowel control. In tethered cord syndrome, nerve signaling
problems may lead to urinary leaks, urgency, retention, or accidents.

Intradural vs. Extradural: Terms surgeons use to describe whether something is inside
(intradural) or outside (extradural) the protective covering of the spinal cord called the dura
mater. Many tethered cord releases are intradural procedures.

Intraoperative Neuromonitoring (IONM or IOM): Real‑time monitoring of nerve and spinal
cord function during surgery to help surgeons avoid injury to critical nerves.

Leg/Back Pain: One of the core symptom categories in tethered cord syndrome. Pain may
worsen with activity, growth spurts, or prolonged sitting.

Low‑lying Conus: The lower end of the spinal cord (conus) sits farther down the spine than
expected (below the usual L1–L2 level). This is often seen in patients with tethered cord.

Motor Changes: Weakness, decreased coordination, foot drop, or changes in muscle tone
(tight or floppy) that may occur when nerves affected by tethering are under stress.

MRI (Magnetic Resonance Imaging): A non‑invasive scan that shows detailed pictures of the
spine and spinal cord. MRI can reveal signs like a low‑lying conus, fatty filum, lipoma, split cord
malformation, or other anomalies, but some patients have normal imaging and still have
symptoms.

Neurogenic Bladder: Bladder function problems caused by nerve issues. Symptoms may
include urinary retention, frequency, urgency, leaking, or recurrent UTIs. Urology testing can
help guide treatment.

Neurocutaneous Markers: Skin findings over the lower spine that may hint at an underlying
spinal difference. Examples: dimples above the gluteal crease (especially if deep or high), hair
tufts (“faun tail”), skin tags, hemangiomas, lipomas, or small openings. Not all are serious, but
they should be mentioned to your provider.

Neurological Leg Symptoms: Numbness, tingling, burning, cramps, weakness, or changes in
sensation or reflexes—all part of the core symptom categories for tethered cord syndrome.

Occult Tethered Cord: When a patient has symptoms consistent with tethered cord syndrome
but imaging (like MRI) does not show a clearly low conus, fatty filum, or visible tether. Diagnosis
relies heavily on symptoms and experienced clinical evaluation.

Orthopedic Deformities: Structural differences in bones, joints, or alignment—such as
scoliosis, foot deformities (clubfoot, cavus foot), or leg length differences—that can be seen in
some patients with tethered cord or related spinal conditions.

Orthotic Braces: External supports used to help with walking, alignment, or muscle weakness
that may occur with tethered cord or related conditions.

Paresthesia: Abnormal sensations such as tingling, pins‑and‑needles, buzzing, or “falling
asleep” feelings in the legs or feet. This may be intermittent or persistent.
Primary Tethered Cord Syndrome: Present at birth (congenital) and not caused by later
trauma, surgery, or scarring.

Progressive Symptoms: Symptoms that get worse over time, which is an important red flag in
tethered cord. It’s important to track changes such as increasing pain, new weakness, or
worsening bladder control and report them to your care team.

Retethering: When the spinal cord re‑adheres to tissue or scar after a prior tethered cord
release, leading to the return or progression of symptoms. Follow‑up care and symptom tracking
are important.

Secondary Tethered Cord Syndrome: Occurs after birth due to a cause such as scar tissue
from prior spinal surgery, trauma, infection, or other spinal conditions.

Sensory Changes: Altered feeling in the legs, feet, or saddle area (the region that would sit on
a bicycle seat). This can include numbness, decreased temperature sensation, or abnormal
responses to touch.

Spina Bifida Occulta: A mild form of spina bifida in which one or more vertebrae don’t fully
close but the spinal cord may appear covered. This is sometimes associated with tethered cord.

Surgical Consent: Before tethered cord release, surgeons discuss expected benefits (relief of
progression, sometimes improvement in symptoms), possible risks (CSF leak, infection, nerve
injury), and long‑term follow‑up. Make sure all your questions are answered.

Tethered Cord / Tethered Spinal Cord: The spinal cord is abnormally fixed to surrounding
tissue and cannot move freely inside the spinal canal.

Tethered Cord Syndrome (TCS): A progressive condition diagnosed using symptom clusters in
three main areas: (1) leg/back pain; (2) neurological leg symptoms (weakness, numbness, gait
changes); and (3) bowel and/or bladder dysfunction. Often, but not always, accompanied by
findings like a low‑lying conus, fatty filum, skin markers, or orthopedic differences. Standard
treatment is surgical release, usually by sectioning (cutting) or removing the filum terminale.

Toe‑Walking: Walking on the balls of the feet or toes rather than the whole foot. Persistent
toe‑walking in children can have many causes; in some cases, neurological or orthopedic
evaluation is warranted when tethered cord is suspected.

Urodynamic Testing (UDS): Specialized bladder testing that measures how the bladder fills,
stores, and empties urine. This test helps determine whether bladder symptoms may be related
to nerve problems such as those seen in tethered cord.

Urinary Retention: Difficulty emptying the bladder completely. This can lead to frequent
urination, dribbling, or urinary tract infections. If suspected, medical evaluation is important.

Vertebra (plural: Vertebrae): The individual bones that stack to form the spine. Doctors often
describe locations in the spine using vertebral levels, such as L1 (first lumbar vertebra) or S1
(first sacral vertebra). These landmarks help describe where the conus ends, where surgery
occurred, or where abnormalities are seen.