Saturday, June 27, 2009

Is it Saturday already??

I guess I should resume with the tethered cord post! The brain has been revived at least halfway, but this week at work really didn't help...
Oh, hold on, I have a Tylenol stuck in my throat, can't get it down... BRB...

Tethered Spinal Cord

The spinal cord is attached in the spianl canal, but kind of free floating if you will. It has nerves that branch off to the various parts of the body, and then a "rubber band" like filament (filum terminale)that secures it to the tailbone (sacrum). Although it is attatched to these, it still has a little "wiggle room", which allows the cerebrospinal fluid to move around the cord.
There are a lot of different problems that cause a cord to be tethered. Most begin when a baby is in early pregnancy, which is when the spinal cord is developed. There is a great deal involved in this, along with tethering, so deal with me because my brain does not feel up to writing the book it would require to explain it all!!

To make it a little easier we'll focus on a tethered cord caused by a tight filum terminale. This is what most adults who are diagnosed with a tethered cord have. The reason is because if the spinal cord itself is tethered the resulting nerve damage would show up at a much younger age. As children grow the spinal cord itself grows, but it also moves upward in the spinal canal. Soooo... If a cord is attached higher it will cause problems earlier in growth as the cord pulls tight on its way up the canal.

With a filum terminale that is too tight the problems will not begin to show until later, because it is loose until the spine reaches the point of overstretching.

Think of it like a rubberband. Grab it at both ends and pull slowly. It is loose most of the time you are pulling, until it reaches that point where it starts to stretch.
With the cord a little stretching isn't a big problem, but the more tight you get the more the nerves are stretched and irritated.

So what problems does it cause?

Well the nerves from the lower part of the spine there innervate the bladder, bowels, and legs.

Urinary symptoms-- frequency and urgency to go (you know like the commercial "gotta go... gotta go... gotta go...)urine leaking, frequent infections, trouble starting a stream, or holding it in.

Bowel symptoms-- constipation/diarhea

Other-- weakness in the legs, tingling, pain or numbness in the legs/feet, numb soles of the feet, unsteady gait (walking), lower back pain that is relieved when the individual lays on the side and curls the legs inward.

So why do the docs suspect that I have a tethered cord? Well, I had some urology (bladder) testing done that showed that I have what is called a neurogenic bladder. It's very irritable and doesn't hold very much before the nerves say I have to go go go... Plus I have a lot of lower back pain that was worse when the doc stretched my spine and better when he curled my knees in to my chest. The other test he did was he had me walk on my toes and as a result I had to go pee. Unfortunatley you can't see a tight filum terminale on an MRI unless it actually pulls the cord down farther than where it is supposed to be. Because of that, making the diagnosis is controversial without physical evidence, especially if there are other things that could be causing the symptoms. Everyone knows I have had 4 kids... So, the docs want me to have a prolapsed bladder ruled out before they will consider the detehering.

Does it have to be detethered??
Well, I asked one of the nurse specialists that I work with that very question. In my mind I thought if the symptoms aren't going to get any worse, why have surgery? But, she is an expert in this area. She specializes in neurogenic bowels and bladders, and said that the symptoms will only get worse because the nerves are impinged and irritated. She very frankly informed me that if I didn't have the detethering eventually the periodic leaking would lead to all the time leaking and the need to cath myself for loss of urine function, that is if the frequent UTI's didn't destroy my kidneys frst. I thought maybe she was exaggerating just a bit until I realized that I no longer feel when I have a UTI. No burning, no kidney pain... It's disturbing.

She also said the irritated nerves will cause further problems with walking if left tight...

How do you detether it? Well, a neurosurgeon will clip the filum terminale, or whatever else is restricting the movement of the cord. SOunds easy doesn't it? Keep in mind that the slip of the blade could mean paralysis... No picnic...
Anyways, there is so much more involved that I would seriously have to write a book, so please don't think this the world renown writings on tethered cord! Haha.

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