Quick answer: Yes, medications can often help manage symptoms that may occur with a tethered spinal cord after SCI, including neuropathic pain, spasticity/tone, some bladder symptoms, and autonomic issues. But medications do not untether the spinal cord; they treat symptoms rather than the underlying loss of the spinal cord’s normal mobility and impairment of CSF flow. Many people choose medication-based management when symptoms are mild and stable, while surgery is more often considered when symptoms are progressive, when independence is declining, or when pain, spasticity, or autonomic dysreflexia are severe despite appropriate medications.
Key takeaways
- Medications can reduce symptoms (pain, spasticity, autonomic dysreflexia, some bladder issues), but they do not untether the spinal cord.
- Many people can safely choose symptom management and monitoring, especially when symptoms are mild and stable and independence is not lost.
- Surgery is usually considered when symptoms are progressive or independence is declining. This is recommended especially for those with functional loss and severe pain, spasticity, or autonomic dysreflexia not controlled with medication.
What relief is available for symptoms
When you are dealing with a spinal cord injury (SCI), the idea of “one more procedure” can feel exhausting. So, it is a very fair question to ask: can we manage progressive symptoms of a tethered spinal cord with medications and physical therapy, avoiding surgery?
Often, yes. However, it depends on the severity of symptoms, how stable they are and what they are doing to your day-to-day functioning.
What medications and therapies can be beneficial
Your SCI team may use medications and therapies to help ease:
- Neuropathic pain
- Spasticity and tone
- Bowel and bladder issues
- Autonomic symptoms
- Perceived muscular weakness
These treatments may improve comfort and function.
“Medications may help turn down the volume on some symptoms” says Scott P. Falci, MD, a neurosurgeon at the HCA HealthONE Falci Institute for Spinal Cord Injuries in Englewood, CO. “But medications do not untether the spinal cord. They may treat the symptoms, not the cause. Similarly, physical therapy may help reduce perceived muscle weakness, but also does not address the underlying cause.”
When surgery is considered
Having tethering doesn’t automatically mean surgery. Surgery carries risks and each person must weigh the risks and benefits personally.
Surgery becomes more likely when tethering is believed to be contributing to symptoms that are:
- Changing independence
- Causing severe, unrelenting neuropathic pain that medication does not control
- Causing severe spasticity not adequately addressed by medications
- Triggering severe autonomic dysreflexia that is frequent or dangerous and not adequately addressed by medications
- Clearly progressive on exam/imaging after other causes have been ruled out
Learn more about posttraumatic tethered spinal cord and what symptoms it can cause.
Learn more about how posttraumatic tethered spinal cord is diagnosed.