Tight filum terminale syndrome in children: analysis based on positioning of the conus and absence or presence of lumbosacral lipoma.
BACKGROUND
Tight filum terminale syndrome (TFTS) characterized by findings consistent with a tethered cord but with the conus ending in a normal position has only recently been observed in children. In this situation, diagnosis may prove difficult and sectioning of the filum terminale is questionable.


METHODS
Sixty cases of pediatric TFTS were analyzed by methods including spinal X-ray and magnetic resonance imaging (MRI). Twenty-one patients exhibited a normally positioned conus, 18 a low-lying conus, and 21 a low-lying conus with accompanying lumbosacral lipoma. These three groups were compared preoperatively and postoperatively for lumbosacral cutaneous stigmata, vertebral anomalies, concomitant congenital spinal dysraphisms, lower limb deformities, and sphincter dysfunction.


RESULTS
Rates of occurrence of lumbosacral cutaneous stigmata and other concomitant congenital spinal dysraphisms differed significantly among the groups. Differences in other parameters were not observed. All groups responded positively to surgery.


CONCLUSIONS
Pediatric TFTS may involve a normally positioned conus. Diagnosis of pediatric TFTS should be based on clinical presentation, physical and radiological examinations, MRI, and pathologic changes in the filum. When neurological signs accompany such changes, early severing of the filum is indicated regardless of conus position.
Bao
Nan
N
Department of Pediatric Neurosurgery, Shanghai Children's Medical Center/Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong, 200127 Shanghai, China.
Chen
Zhi-Hua
ZH
Gu
Shuo
S
Chen
Qi-Min
QM
Jin
Hui-Ming
HM
Shi
Cheng-Ren
CR
D000293:Adolescent; D002420:Cauda Equina / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008067:Lipoma / Q000150:complications* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D010523:Peripheral Nervous System Diseases / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D013117:Spinal Cord Compression / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000150:complications* / Q000473:pathology*; D013577:Syndrome