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Tethered cord syndrome
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=== Metabolism === Tethered cord, a form of mechanical [[neural strain]], is associated with impaired glucose metabolism in spinal cord tissue,<ref name=":2" /> changes in the reduction/oxidation ratio of [[cytochrome oxidase]].<ref>{{Cite journal | last =Yamada | first = Shoko M. | last2 = Won | first2=Daniel J. | last3 = Yamada | first3=Shokei | date = 2004-02-01 | title = Pathophysiology of tethered cord syndrome: correlation with symptomatology|url=https://thejns.org/view/journals/neurosurg-focus/16/2/foc.2004.16.2.7.xml|journal=Neurosurgical Focus|language=en-US|volume=16|issue=2|pages=1–5|doi=10.3171/foc.2004.16.2.7|issn=1092-0684}}</ref> and reduced ATP production.<ref>{{Cite journal | last =Sullivan | first = Stephen | last2 = Park | first2 = Paul | last3 = Stetler | first3=William R. | date = 2010-07-01 | title = Pathophysiology of adult tethered cord syndrome: review of the literature|url=https://thejns.org/view/journals/neurosurg-focus/29/1/2010.3.focus1080.xml|journal=Neurosurgical Focus|language=en-US|volume=29|issue=1| pages = E2|doi=10.3171/2010.3.FOCUS1080|issn=1092-0684}}</ref> Energy loss due to neural membrane stretching contributes to leakage of [[sodium]], [[potassium]] and [[calcium]].<ref>{{Cite journal | last =Yamada | first = Shokei | last2 = Iacono | first2 = Robert P. | last3 = Andrade | first3 = Terry | last4 = Mandybur | first4 = George| last5 = Yamada | first5 = Brian S. | date = 1995-04-01 | title = Pathophysiology of Tethered Cord Syndrome|url=http://www.sciencedirect.com/science/article/pii/S1042368018304650|journal=Neurosurgery Clinics of North America|series=Spinal Dysraphism|volume=6|issue=2|pages=311–323|doi=10.1016/S1042-3680(18)30465-0|issn=1042-3680}}</ref> A study of energy cost of walking in adolescents with tethered cord, as measured by oxygen uptake, found that “energy cost per metre during walking at preferred speed and physical strain were higher than in peers without disability.”<ref>{{Cite journal | last =Bruinings | first = A. L. | last2 = Berg‐Emons | first2 = H. J. G. Van Den | last3 = Buffart | first3 = L.M. | last4 = Heijden‐Maessen | first4 = H. C.M. Van Der | last5 = Roebroeck | first5 = M.E. | last6 = Stam | first6 = H.J. | date = 2007 | title=Energy cost and physical strain of daily activities in adolescents and young adults with myelomeningocele|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-8749.2007.00672.x|journal=Developmental Medicine & Child Neurology|language=en|volume=49|issue=9 | pages = 672–677|doi=10.1111/j.1469-8749.2007.00672.x|issn=1469-8749}}</ref>
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