Bridging Clinical and Preclinical Perspectives on Spina Bifida and Tethered Cord Syndrome: Presentation, Neurogenic Bowel and Bladder Management, and Animal Models

Although spina bifida (SB) and tethered cord syndrome (TCS) are often discussed and studied as separate conditions, their co-occurrence is common, clinically consequential, and understudied, particularly with respect to neurogenic bladder and bowel dysfunction. SB arises from incomplete neural tube closure, whereas TCS involves abnormal fixation of the spinal cord, often leading to progressive neurologic deficits. SB affects approximately 3.63 per 10,000 live births in the United States, and TCS occurs in a significant proportion of affected individuals; however, the true incidence of their co-occurrence remains unknown. Current clinical strategies include surgical intervention and symptomatic management, but long-term outcomes are variable, and gaps persist in diagnosis, presentation, and optimal treatment. Bladder and bowel dysfunction are among the most prevalent and functionally impactful complications, yet these outcomes are inconsistently documented and rarely tracked longitudinally. Preclinical models in rodent, porcine, ovine, and feline species provide insight into spinal cord development, tethering mechanisms, and functional consequences, but few examine bladder or bowel function. This review synthesizes clinical and preclinical evidence to characterize overlapping SB and TCS presentations, identifies gaps in bladder and bowel outcome reporting, and highlights opportunities to improve translational animal models and long-term care.