Diagnosing a posttraumatic tethered spinal cord typically relies on identifying a pattern of symptoms rather than a single definitive test. Physicians evaluate progressive changes following a spinal cord injury—such as increasing neuropathic pain, loss of sensation, weakness, spasticity, autonomic dysfunction, or bladder and bowel changes. These symptoms are then assessed through a neurological examination and imaging studies, most often MRI and occasionally CT myelography.
Equally important is ruling out other conditions that can produce similar symptoms, including spinal stenosis, disc compression, tumors, vascular abnormalities, spinal instability, or certain neurological diseases.
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Key Points to Understand
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Diagnosis is based on patterns of symptoms over time, supported by neurological exams and imaging.
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Physicians must exclude other medical conditions that can mimic tethered cord symptoms.
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MRI scans are commonly used, but tethering can sometimes be subtle and must be interpreted alongside clinical findings.
What “Posttraumatic Tethered Spinal Cord” Means
After a spinal cord injury, scar tissue may develop between the spinal cord and the surrounding protective layer known as the dura. This scarring can anchor the spinal cord in place.
Under normal conditions, the spinal cord moves freely within the spinal canal as cerebrospinal fluid circulates and as the body bends or stretches. When scar tissue restricts this movement, the cord can become abnormally stretched during everyday motions. Over time, this tension can contribute to additional irritation or injury to the spinal cord, potentially leading to new or worsening symptoms.
When Tethering May Be Suspected
Many individuals with spinal cord injuries eventually reach a stable baseline after the initial recovery period. Doctors begin to suspect tethering when symptoms gradually worsen after this stabilization.
Warning signs that may raise concern include:
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New or increasing neuropathic pain (burning, electric, or sharp sensations)
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Loss of sensation or reduced feeling in the skin
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Declining strength or loss of previously regained function
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Increased muscle stiffness or spasticity
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Changes in bladder or bowel control
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Symptoms of dysautonomia, such as worsening autonomic dysreflexia or unusual sweating
When these symptoms appear or intensify over time, clinicians may begin investigating the possibility of tethering.
The Diagnostic Process
Diagnosing posttraumatic tethered spinal cord usually involves several steps.
1. Reviewing Clinical History
The first step focuses on understanding what has changed and how symptoms are progressing.
Your healthcare team will ask detailed questions about:
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When symptoms began
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Whether symptoms are stable or worsening
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Changes in pain, strength, sensation, or mobility
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Shifts in bladder, bowel, or autonomic function
According to Dr. Scott P. Falci, neurosurgeon at the HCA HealthONE Falci Institute for Spinal Cord Injuries in Englewood, Colorado, the patient’s story is extremely important.
“When someone says, ‘This is not how I usually feel,’ that’s significant,” he explains.
Patterns in symptom progression often provide the first clue that tethering may be occurring.
2. Neurological Examination
Next, physicians perform a detailed neurological exam to compare your current condition with your previous baseline.
This assessment typically evaluates:
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Muscle strength and coordination
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Sensory function
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Reflexes, muscle tone, and spasticity
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Functional abilities such as walking, transfers, hand use, and endurance
Previous medical records—such as rehabilitation notes or earlier neurological exams—can be helpful for identifying changes over time.
3. Imaging Tests
Imaging studies are an important part of the diagnostic process.
MRI scans are usually the preferred method because they provide detailed images of the spinal cord and surrounding tissues. MRI can reveal scarring, compression, or related complications such as syringomyelia, a fluid-filled cavity that can develop in the spinal cord after injury.
If MRI cannot be performed, doctors may use CT myelography, which combines CT imaging with a contrast dye to visualize the spinal canal.
However, tethering may not always appear clearly on imaging. Even when the spinal cord appears centered within the canal, scar tissue can still restrict its mobility. For this reason, imaging results must always be interpreted alongside clinical symptoms and examination findings.
4. Ruling Out Other Possible Causes
Before confirming tethered cord as the cause of symptoms, doctors must exclude other conditions that could produce similar problems.
These may include:
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Spinal stenosis (narrowing of the spinal canal)
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Herniated or compressed discs
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Tumors affecting the spinal cord or surrounding structures
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Vascular malformations
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Spinal instability
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Other neurological disorders such as multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS)
Dr. Falci emphasizes that diagnosis is never based on a single finding.
“We don’t diagnose tethering from one clue,” he explains. “We look for consistent patterns across symptoms, neurological exams, imaging results, and other diagnostic tests.”
Why Diagnosis Requires a Comprehensive Approach
Because many spinal conditions share similar symptoms, diagnosing posttraumatic tethered spinal cord requires careful evaluation of the entire clinical picture. Doctors rely on a combination of patient history, physical examination, imaging studies, and exclusion of other disorders to determine whether tethering is responsible for the symptoms.
By identifying the pattern early, clinicians can determine the most appropriate next steps for treatment and management.