A child with spina bifida presents with sudden increase in scoliosis, hypertonus/loss of LE function, change in gait pattern, change in bowel/bladder habits, and back/buttock pain. What is the concern?

• A. Spinal stenosis
• B. Muscle contracture
• C. Tethered cord
• D. Leg length discrepancy

Answer: (C)

Tethered cord syndrome is the concern here. In kids with spina bifida, the spinal cord can be abnormally attached inside the spinal canal, so as the child grows the cord is stretched. This traction on the cord leads to progressive neurologic changes, including new or worsening leg spasticity and weakness, changes in gait, worsening scoliosis, and autonomic symptoms such as changes in bowel and bladder function. Back or buttock pain from the traction is also common.

This fits best because the combination of rapid scoliosis progression, lower-extremity neurologic change, gait alteration, new bowel/bladder symptoms, and axial pain points to a tethered cord process rather than other possibilities. Spinal stenosis is unlikely in a child and wouldn’t typically present with new autonomic changes. Muscle contracture explains stiffness or limited range but not new neurologic decline or autonomic symptoms. Leg length discrepancy is a structural issue and doesn’t account for the neurologic and autonomic signs.