Occult tight filum terminale syndrome: results of surgical untethering.
The entity of an occult tight filum terminale syndrome, characterized by clinical findings consistent with a tethered cord syndrome, but with the conus ending in a normal position, has been recognized recently. The indications for sectioning the filum terminale in this situation are not well characterized and are controversial. We report a retrospective review of a consecutive series of 60 children (ages 3-18 years) with a diagnosis of occult tight filum terminale syndrome who underwent section of the filum and were followed for more than 6 months (mean 13.9 months). The criteria for surgical intervention were (1) spina bifida occulta, (2) progressive bladder instability unresponsive to conservative measures, (3) urological/nephrological evaluation to confirm or rule out nonneurogenic etiology, and (4) two or more of the following: (a) bowel involvement (fecal incontinence or chronic constipation), (b) lower extremity weakness, (c) gait changes, (d) reflex/tone abnormalities, (e) sensory disturbances, (f) back/leg pain, (g) orthopedic abnormalities/limb length discrepancy, (h) scoliosis/lordosis, (i) recurrent urinary tract infections, (j) abnormal voiding cystourethrogram/ultrasound, (k) syringomyelia, and (l) neurocutaneous stigmata. Postoperatively, urinary incontinence/retention showed complete resolution in 52%, marked improvement (>95% resolution) in 35%, moderate improvement (>75%) in 6%, minimal improvement (> 50%) in 6%, and no improvement (<50%) in 2%. Fecal incontinence completely resolved in 56%, improved in 41%, and was unchanged in 3%. Weakness, sensory abnormalities, and pain improved or resolved in all patients.
Wehby
Monica C
MC
Divisions of Pediatric Neurosurgery and Pediatric Urology, Emanuel Children's Hospital, Portland, Oreg., USA. monicawehby@hotmail.com
O'Hollaren
Patrick S
PS
Abtin
Keyvan
K
Hume
Jenny L
JL
Richards
Benjamin J
BJ
D000293:Adolescent; D002420:Cauda Equina / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy; D017843:Ligamentum Flavum / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D009436:Neural Tube Defects / Q000175:diagnosis / Q000601:surgery*; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016136:Spina Bifida Occulta / Q000175:diagnosis / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*