Filum terminale transection in pediatric tethered cord syndrome: a single center, population-based, cohort study of 95 cases

Abstract

Purpose The purpose of this study was to evaluate outcome following surgical transection of filum terminale (FT) in symptomatic and asymptomatic pediatric patients with radiological findings consistent with tethered cord syndrome (TCS). Methods Patients < 17 years who underwent untethering surgery between 2007 and 2018 were screened for eligibility. Those who had undergone primary transection of the FT, and had preoperative radiological findings of fatty filum, thickened FT, or low-lying conus, below the pedicles of L2, were included. The cohort was divided into symptomatic and asymptomatic depending on clinical presentation. Surgical complications and functional outcome was recorded. Results In total, 95 patients were included, of whom 62 were symptomatic. In symptomatic patients, the main indications for radiological evaluation were scoliosis (29%) and motor symptoms (19%). In asymptomatic patients, skin stigmata (76%) were the most common finding. Fatty or thick FT was the most common radiographic finding, seen in 61% of symptomatic and 79% of asymptomatic cases. All patients underwent transection of the FT and were followed for a median of 1.8 years. A postoperative complication occurred in 12%, all Ibanez type Ib and managed without invasive treatment. For the symptomatic cohort, significant improvement was seen for both urodynamic assessment (48% improved, p = 0.002) and sensorimotor function (42% improved, p < 0.001). Conclusions Neurological improvement or halted deterioration was seen in the majority of symptomatic cases. Asymptomatic patients did not experience any severe complications. Filum transection should be offered to symptomatic and asymptomatic patients upon diagnosis of fatty filum, thickened FT, or low-lying conus.

Treatment of an anterior cervicothoracic myelomeningocele together with spine deformity correction in a child: illustrative case

“…[14][15][16] Early surgical detethering reduces mechanical traction on the spinal cord and can prevent the development of neurological deficits and halt further deterioration. 17 Using a multidisciplinary strategy, we performed a combined anteriorposterior approach to resect the myelomeningocele, detether the spinal cord, and correct the scoliotic deformity. The surgical approach performed by the otolaryngologists was critical in providing the wide operative exposure necessary to carefully dissect and resect the myelomeningocele.…”

Endoscopic spinal cord untethering using a 1 cm skin incision technique in pediatrics: a technical case report

“…The classical surgical treatment of filar lipoma is one-level laminectomy or laminectomy and microsurgical sectioning of the filum terminale [ 8 , 9 ]. To keep surgical invasiveness and complications to a minimum, minimally invasive techniques such as the interlaminar approach or endoscopic-assisted techniques have been increasingly used in recent years [ 5 , 9 – 12 ].…”