Tethered cord syndrome is a complex condition with a wide range of possible signs and symptoms. Because the spinal cord is under abnormal tension, symptoms can involve multiple systems of the body and may change or worsen over time. Early recognition and evaluation are key to preventing permanent nerve damage.
Below are some of the most common signs and symptoms that may warrant an evaluation by a medical provider familiar with tethered cord syndrome:
Neurological symptoms:
- Leg weakness, numbness, or tingling
- Changes in gait (toe walking, limping, dragging one leg)
- Poor coordination or frequent tripping
- Muscle tightness or spasticity
- Loss of reflexes or abnormal reflexes
- Hyperreflexia (overly exuberant reflexes, especially in the lower body)
- Asymmetrical symptoms (right vs. left)
Pain:
- Lower back pain, especially in the sacral area
- Leg pain, often described as burning or radiating
- Pain that worsens with activity or improves when lying down
- Headaches or neck pain, especially in cases involving overlapping conditions such as Chiari
Bladder and Bowel Dysfunction:
- Urinary urgency, frequency, or incontinence
- Sphincter dysfunction, pain, and/or spasming
- Difficulty starting urination or fully emptying the bladder
- Recurrent urinary tract infections
- Constipation or fecal incontinence
- Daytime or nighttime accidents beyond typical age ranges
Orthopedic Signs:
- Scoliosis (side-to-side curvature of the spine)
- Lordosis/kyphosis (straightening or exaggeration of the spine’s front-to-back curvature)
- Leg length discrepancy
- High foot arches
- Clubfoot
- Toes that curl under on one or both feet
- Uneven muscle tone in the legs
Skin and Physical Findings
- A dimple, tuft of hair, skin tag, or discoloration on the lower back
- Asymmetrical gluteal crease
- Two gluteal creases instead of one
- Signs of spinal dysraphism (visible or subtle abnormalities in the skin overlying the spine)
- Lipoma or fatty mass over the lower spine
- Hemangioma (raised red or purple birthmark) on the lower back
Developmental or Functional Changes
- Regression in motor milestones or toilet training
- Decline in physical abilities or endurance
- Unexplained changes in behavior or mood, especially in children experiencing chronic discomfort
- Sensory processing difficulties (over- or under-sensitive to touch or stimuli)
If you or someone you care for is experiencing one or more of these symptoms, especially multiple symptoms in two or more categories, it may be worth seeking an evaluation from a neurosurgeon experienced in tethered cord syndrome. Imaging alone may not always show the problem: a careful clinical assessment is essential. Sometimes it can also be helpful to seek more than one medical opinion.
Symptom Tracking Tips
Keeping good records can help your medical team make decisions about evaluation and treatment. Writing down any relevant information and how it changes over time can help both you and your provider understand your situation better.
- Monitor bladder and bowel changes: accidents, urgency, constipation, UTIs.
- Note gait changes: toe‑walking, tripping, needing new braces. Videos can be helpful for gait changes that occur only in certain situations (running, jumping, with fatigue, etc.)
- Record growth milestones in children (rapid growth can stress a tether).
- Track changes in range of motion or physical ability over time, including specific measurements and how certain activities and activity duration affects your symptoms when possible.
Medically Reviewed and Updated 1 August 2025