The Effect of Tethered Cord Release on Coronal Spinal Balance in Tight Filum Terminale

Abstract BACKGROUND: Section of a tight filum terminale is a minimally invasive procedure compared with cord untethering procedures used for more complex spinal abnormalities. Anecdotal evidence suggests, however, that the risk of symptomatic retethering resulting from scarring might be higher than previously thought. OBJECTIVE: To determine the frequency of symptomatic retethering after section of a tight filum terminale and to explore possible risk factors. METHODS: We reviewed databases at 2 pediatric neurosurgery centers for all patients who had surgery for a suspected tight filum terminale between January 1982 and June 2009. RESULTS: We identified 152 patients. The median length of follow-up was 78 months. Thirteen patients (8.6%) went on to retether symptomatically at a median time of 23.4 months after the initial procedure. Eight had early retethering (within 2 years) and 5 had late retethering (after 7 years). Compared with late retetherers, early retetherers were older at initial surgery (median, 9.4 vs 0.9 years of age), had a higher level of the conus (median, L1/L2 vs L3/L4), had more arachnoiditis after initial surgery, and required more repeat untethering procedures. Late retetherers were younger at initial surgery than those who did not retether (median, 0.9 vs 4.5 years of age). CONCLUSION: Symptomatic retethering is not uncommon after a simple filum snip, and long-term follow-up is warranted. Two distinct patterns of retethering were observed. Arachnoiditis caused by infection or a cerebrospinal fluid fistula may predispose to early retethering, whereas early surgery for prevention of tethered cord symptoms may predispose to late retethering.

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Urodynamic evaluation of tethered cord syndrome including tight filum terminale Prolonged follow-up observation after intraspinal operation

Urology ◽

10.1016/0090-4295(80)90620-2 ◽

1980 ◽

Vol 16 (5) ◽

pp. 539-552 ◽

Cited By ~ 18

Author(s):

Junnosuke Fukui ◽

Tsutomu Kakizaki

Keyword(s):

Tethered Cord ◽

Tethered Cord Syndrome ◽

Filum Terminale ◽

Urodynamic Evaluation ◽

Tight Filum Terminale

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Real spinal cord injury without radiologic abnormality in pediatric patient with tight filum terminale following minor trauma: a case report

BMC Pediatrics ◽

10.1186/s12887-019-1894-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Qin Chuan Liang ◽

Bo Yang ◽

Yun Hai Song ◽

Pin Pin Gao ◽

Ze Yang Xia ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Symptoms ◽

Tethered Cord ◽

Trauma Patients ◽

Minor Trauma ◽

Filum Terminale ◽

Predisposing Factor ◽

Cord Injury ◽

Tight Filum Terminale

Abstract Background Spinal cord injury without radiographic abnormality (SCIWORA) is defined as having “clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability”. The mechanism of pediatric SCIWORA following minor trauma is still unclear. Tight filum terminale (TFT) has been studied in the literature, but the information regarding the predisposing factor for SCIWORA is still being defined. Case presentation We report three cases of thoracic and lumber SCIWORA with TFT. The trauma was potentially mild in all cases but resulted in catastrophic damage of the cord. All patients had no signs or symptoms of tethered cord syndrome prior to the minor trauma. TFT was found during operation. Conclusions We suggest that TFT might be a predisposing factor for SCIWORA and chronic spinal cord traction play an important role in the mechanism of pediatric thoracic and lumber SCIWORA following minor trauma. Patients who never undergo treatment for TFT likely have an elevated risk of developing SCIWORA following minor trauma.

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Comparison of The Electrophysiological Characteristics of Tight Filum Terminale And Tethered Cord Syndrome

10.21203/rs.3.rs-977337/v1 ◽

2021 ◽

Author(s):

Naosuke Kamei ◽

Toshio Nakamae ◽

Kazuyoshi Nakanishi ◽

Taiki Morisako ◽

Takahiro Harada ◽

...

Keyword(s):

Healthy Subjects ◽

Motor Evoked Potential ◽

Tethered Cord ◽

Compound Action Potential ◽

Conduction Time ◽

Filum Terminale ◽

Abductor Hallucis ◽

Abductor Pollicis Brevis ◽

Compound Muscle Action Potentials ◽

Tight Filum Terminale

Abstract This study aims to characterize tight filum terminale (TFT) in motor evoked potential (MEP) testing by comparing TFT patients with both tether cord syndrome (TCS) patients and healthy subjects. Fifty TFT patients, 18 TCS patients, and 35 healthy volunteers participated in this study. We recorded MEPs following transcranial magnetic stimulation from the bilateral abductor hallucis muscles as well as compound muscle action potentials and F-waves evoked by electrical stimulation of the tibial nerve from the bilateral abductor pollicis brevis muscles. The peripheral conduction time (PCT) was calculated from the latency of the compound action potential and F-wave. Furthermore, the central motor conduction time (CMCT) was calculated by subtracting PCT from MEP latency. TFT and TCS patients had a significantly longer MEP latency than healthy subjects. PCT in TFT patients were significantly longer than those in TCS patients or healthy subjects. Using the cut-off values for PCT, we were able to diagnose patients with TFT patients with a sensitivity of 72.0% and a specificity of 91.4%. Prolonged PCT in the MEP test may be a useful indicator for TFT and suggests that MEP may be used as an adjunct diagnostic tool for TFT.

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Preventing cerebrospinal fluid leak following transection of a tight filum terminale

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.4.peds10502 ◽

2011 ◽

Vol 8 (1) ◽

pp. 35-38 ◽

Cited By ~ 15

Author(s):

Joshua J. Chern ◽

R. Shane Tubbs ◽

Akash J. Patel ◽

Amber S. Gordon ◽

S. Kathleen Bandt ◽

...

Keyword(s):

Univariate Analysis ◽

Operating Time ◽

Tethered Cord ◽

Cerebrospinal Fluid Leak ◽

Csf Leak ◽

Complication Rates ◽

Filum Terminale ◽

Csf Leakage ◽

Tight Filum Terminale ◽

The Individual

Object Tethered cord release for a tight filum terminale is a common pediatric operation associated with low morbidity and mortality rates. While almost all would agree that keeping patients lying flat after the operation will prevent a CSF leak, the optimal period of doing so has not been determined. In this study, the authors examined whether a longer length of stay in the hospital for the sole purpose of maintaining patients flat correlates with a decreased rate of CSF leakage. Methods Intraoperative and postoperative data were retrospectively collected in 222 cases of simple tethered cord release at 3 large children's hospitals. Risk factors for postoperative CSF leakage were identified. Results Thirty-eight patients were maintained lying flat for 24 hours, 86 for 48 hours, and 98 for 72 hours at the individual surgeon's discretion. A CSF leak occurred in 13 patients (5.9%) and pseudomeningocele developed in 9 patients (4.1%). In the univariate analysis, operating time, use of the microscope, use of dural sealant, and duration of remaining flat after surgery failed to correlate with the occurrence of complications. Conclusions A longer hospital stay for maintaining patients flat after a simple tethered cord release appears not to prevent CSF leakage. However, a larger patient cohort will be needed to detect small differences in complication rates.

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