Management of Tight Filum Terminale

doi:10.1055/s-2003-812463

Cited by 26 publications

(7 citation statements)

References 3 publications

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“…These are similar to those reported by Yong et al [1]. Bao et al [16] and Komagata et al [17] also found that bladder/bowel dysfunction was the most common presenting symptom and that the majority of patients improved with filum terminale sectioning. Improvement of bladder/bowel dysfunction (84%) and neuroorthopedic abnormalities (92.3%) were similar to other reports.…”

Section: Discussionsupporting

confidence: 90%

Retethering in Children after Sectioning of the Filum Terminale

Vassilyadi¹,

Tataryn²,

Merziotis³

2012

Pediatr Neurosurg

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Background/Aim: Sectioning of the filum terminale is performed when spinal cord tethering is suspected, sometimes without clinical symptoms. Retethering can occur and require reoperation due to the presentation of either recurrent or new symptoms. The purpose of this institutional review was to identify the retethering rate in children, especially in those who were initially asymptomatic, and to discuss the role of surgery. Methods: The medical records of all children at the Children's Hospital of Eastern Ontario (CHEO) who underwent tethered cord surgery between 1978 and 2009 for a thickened filum terminale were retrospectively reviewed, as well as those who retethered. Results: A total of 146 patients with a mean age of 4.3 years underwent a low lumbar single or partial laminectomy for sectioning of the filum terminale; 44 patients (30.1%) were asymptomatic at the time of surgery, 51.4% had bladder and bowel dysfunction, 26.7% had neuroorthopedic findings, 15.8% had pain and 6.2% had progressive scoliosis; 11 children with a median age of 8.9 years had symptoms of retethering requiring reoperation (median time to retether was 4.3 years) and 4 were initially asymptomatic. Repeat surgery was successful at alleviating the new symptoms that occurred as a result of retethering. Conclusions: Of the 146 patients at CHEO who underwent surgery, 7.5% retethered, with 36% being initially asymptomatic. Those operated in the first year of life were not found to be at a higher risk. The level of the conus medullaris did not influence the rate or retethering or urological dysfunction. Children who were initially asymptomatic improved after surgery for retethering, but may not have required surgery in the first place.

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Section: Discussionsupporting

confidence: 90%

Retethering in Children after Sectioning of the Filum Terminale

Vassilyadi¹,

Tataryn²,

Merziotis³

2012

Pediatr Neurosurg

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“…TFT has often been acknowledged to be difficult to diagnose because of nonspecific symptoms and unclear imaging findings [ 6 ]. As a diagnostic approach, it is important to first identify TFT as a differential, as in this case, and consider the diagnostic criteria developed by Komagata et al [ 4 ], consisting of a medical interview and physical examination findings. In addition, a supine MRI scan should be performed, as in the present case, to aid in diagnosis [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since then, TFT has been suggested to possibly occur in approximately 14–28% of patients with TCS [ 3 ]. In TFT, hypertonia of the filum terminale causes spinal cord traction, resulting in neurological symptoms inconsistent with the dermatome, as well as bladder and rectal disturbances [ 4 ]. In children, incontinence and frequent urination occur, with incontinence being particularly common.…”

Section: Introductionmentioning

confidence: 99%

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Atypical presentation of tight filum terminale with thoracic disc herniation: a case report

Miyagami,

Nojiri,

Okada

et al. 2024

J Med Case Reports

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Background Tight filum terminale is a rare and challenging condition to diagnose because it presents with nonspecific symptoms and unclear imaging findings. This report documents an atypical case of tight filum terminale. Case presentation The patient was a previously healthy Asian 18-year-old male presenting with recurrent upper extremity and back pain, initially treated as nonspecific musculoskeletal pain. Notably, the patient’s symptoms were inconsistent with the dermatome, showing no correlation with his skin’s sensory innervation areas. In contrast to typical tight filum terminale presentations focused on lower extremity and lumbar region disturbances, this patient experienced pain and weakness predominantly in the upper extremities and back, hypothesized to result from traction myelopathy exacerbated by thoracic disc herniation. Investigations including blood and nerve function tests were inconclusive. However, a magnetic resonance imaging scan revealed a combination of tight filum terminale and tiny thoracic disc herniation. A diagnosis of tethered spinal cord syndrome was confirmed following further tests and imaging. The filum terminale was surgically removed, resolving the symptoms at a 7-month follow-up. Conclusions This case underlines the importance of including tight filum terminale as a differential diagnosis in cases of unexplained upper or lower extremity pain. Primary care practitioners, particularly those managing undefined symptoms, should consider tight filum terminale in their diagnostic approach.

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“…TFT is often diagnosed at a young age because height gain results in increased tension in the terminal laments, which often affects the medullary conus 15 . Patients with TCS were diagnosed at an even younger age than those with TFT; however, in this study, they underwent MEP testing because their symptoms worsened in adulthood.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the electrophysiological characteristics of tight filum terminale and tethered cord syndrome

et al. 2022

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This study aims to characterize tight lum 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 signi cantly longer MEP latency than healthy subjects. PCT in TFT patients were signi cantly 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 speci city 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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Management of Tight Filum Terminale

Cited by 26 publications

References 3 publications

Retethering in Children after Sectioning of the Filum Terminale

Retethering in Children after Sectioning of the Filum Terminale

Atypical presentation of tight filum terminale with thoracic disc herniation: a case report

Comparison of the electrophysiological characteristics of tight filum terminale and tethered cord syndrome

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