Pathophysiology of tethered cord syndrome.

Tethered cord syndrome, manifested by motor and sensory dysfunction and incontinence, is caused by excessive tension in the lumbosacral cord. The underlying mechanism is related to impairment of oxidative metabolism in this region. This theory is derived from redox changes of cytochrome a, a3, and supported by spinal cord blood flow, evoked potential, and histological studies. The well-known finding of elongated spinal cord attached to the tight filum or a tumor is not always demonstrated in imaging studies, and understanding of pathophysiology allows physicians to correctly diagnose and treat patients with tethered cord syndrome.