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Tethered spinal cord syndrome (TSCS), also known as occult spinal dysraphism sequence, is a congenital condition that causes the spinal cord, before or after birth, to become attached to the spinal column at some point along its length, most often in the lower (lumbar) portion. TSCS is related to spina bifida, since both disorders arise from a failure of the neural tube to close completely during embryonic development.
There are differing forms and degrees of severity of TSCS, including tight filum terminale, lipomeningomyelocele, split cord malformations, and dermal sinus tracts.
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Causes and symptoms
Congenital TSCS is initiated by incomplete closure of the neural tube during embryonic development. During the eighteenth to twenty-second day of embryonic development, the beginning structure of the neural tube, which will become the spinal column and cord, is formed by ectodermal tissue on the back of the embryo that forms a groove, which deepens and forms into a hollow tube, still open dorsally along its length.
The tube begins to close itself, starting in the thoracic region, then moving on toward the head and lumbar regions. During the twenty-eighth to forty-eighth day of development, ectodermal tissue in the tail area of the embryo forms a separate, short length of neural tube, the conus medullaris, whose anterior end meets and fuses with the main neural tube while the posterior forms the filum terminale. The conus medullaris also produces the cauda equinae nerves.
Symptoms of TSCS may be visible at birth or appear later, even in adulthood, but most often in childhood. The symptoms may be visible or behavioral. Various visible signs on the skin of the lower back, along and near the spinal cord, are:
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