{"id":15142,"date":"2026-03-29T00:00:54","date_gmt":"2026-03-28T23:00:54","guid":{"rendered":"https:\/\/dev.institutchiaribcn.com\/enfermedades\/tethered-cord-with-occult-spina-bifida-or-occult-tethered-cord-syndrome\/"},"modified":"2026-03-30T13:10:03","modified_gmt":"2026-03-30T11:10:03","slug":"tethered-cord-occult-spina-bifida-occult-tethered-cord-syndrome","status":"publish","type":"enfermedades","link":"https:\/\/institutchiaribcn.com\/en\/tethered-cord-occult-spina-bifida-occult-tethered-cord-syndrome\/","title":{"rendered":"Occult Tethered Cord Syndrome"},"content":{"rendered":"
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Last update: 03\/20\/2026, <\/strong>Dr. Miguel B. Royo Salvador<\/strong><\/a>, Medical Board number 10389.<\/strong> Neurosurgeon y Neurologist.<\/strong><\/p>\n

Definition<\/strong><\/h2>\n

In normal conditions, the spinal cord is held within the spinal canal only by the denticulate ligaments and the filum terminale, a ligament that connects the conus medullaris to the first coccygeal vertebrae.<\/p>\n

When the mobility of the spinal cord within the bony spinal canal is limited by the presence of a non-visible spina bifida that produces a tethering, the clinical picture is defined as Tethered Cord Syndrome.<\/strong><\/p>\n

The Tethered Cord Syndrome <\/strong>can be congenital <\/strong> or acquired.<\/p>\n

The Tethered Cord Syndrome with occult spina bifida<\/strong> or \u201cOccult<\/strong> Tethered Cord Syndrome<\/strong>\u201d \u201d is congenital.<\/p>\n

Occult tethered cord or \u201cOccult Tethered Cord Syndrome\u201d is associated with an occult spina bifida<\/strong>. This is a neuro-spinal malformation that is characterized by the incomplete development of the spinal cord (predominantly in the lumbar region) which is anchored by the malformation, producing mechanical injuries due to the traction, mainly in the spinal cord and spine (Fig.1<\/em>).<\/p>\n

A spina bifida is defined as occult<\/em><\/strong> when it is not visible externally. This is the most common and mildest type of spina bifida, that produces a small separation or gap in one or more vertebrae of the spine. Sometimes it is possible to observe visible signs on the newborn\u2019s skin above the spinal defect, such as a birthmark, an abnormal tuft of hair or a dimple.<\/p>\n

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\nFig.1<\/div>\n
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Diagnosis<\/strong><\/h2>\n

The clinical picture of a tethered cord with occult spina bifida can be determined at birth, although in most patients the neurological symptoms and signs develop in the first two decades of their life, mainly during adolescence, hence the diagnosis is usually made in adulthood. Many patients actually discover the condition through tests done for unrelated reasons.<\/p>\n

To detect and diagnose it, it is necessary to perform complementary tests like a Nuclear Magnetic Resonance (MR) or a Computerized Axial Tomography (CT) or a simple X-ray of the spine level where the tethering is located.<\/p>\n

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Symptoms<\/strong><\/h2>\n

As the spinal nerves are usually not involved in a tethered cord with occult spina bifida, there may be no manifest sign or symptom in the whole patient\u2019s life, or they can remain mild for many years.<\/p>\n

Apart from the mentioned skin<\/strong> marks<\/strong>, in most cases symptoms mainly consist of: sensitivity and motor disorders in the lower extremities, with weakness that can cause gait difficulties, sphincter alterations<\/strong> \u2013 such as neurogenic bladder \u2013<\/strong> that manifests with enuresis or repeated urinary infections<\/strong>, and pain-related symptoms<\/strong> especially in the lumbar spine, sciatica, etc.<\/p>\n

Once the neurological symptoms appear, most of them are irreversible. Therefore, these conditions need an early diagnosis, in order to prevent them through treatment.<\/p>\n

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Causes<\/strong><\/h2>\n

The causes of occult spina bifida and, consequently, of the associated tethered cord, are the result of a combination of genetic predisposition, environmental factors and family history.<\/strong> They can be related to neural tube defects and folate deficiency.<\/strong><\/p>\n

In general, the neural<\/strong> tube <\/strong>forms in the early stages of pregnancy and closes by day 28 after conception. In babies with spina bifida, both mild and occult, part of the neural tube does not form or close properly, producing defects in the development of the spinal cord and vertebral column. This malformation is usually associated with the presence of low levels of folic acid<\/strong> during pregnancy.<\/p>\n

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Risk Factors<\/strong><\/h2>\n

Some factors are associated with an increased risk of occult spina bifida:<\/p>\n