Purpose: Retethering after transection of a tight filum terminale (TFT) deemed to be a rare and usually only years after initial surgery occurring complication. Possible perioperative factors that might influence the retethering rate or help to allow a prognostic risk assessment are still poorly investigated. The aim of this study was to analyze our patient cohort who underwent a TFT transection by assessing clinical outcome, retethering rate, and pre- and postoperative MRI studies.
Methods: All consecutive patients undergoing transection of a TFT from January 2011 to December 2018 were evaluated. Inclusion criteria were defined as exclusive TFT intervention and a minimum follow up period of 1 year. Epidemiological data, treatment modalities, complication characteristics, and MRI studies were recorded and analyzed.
Results: A total of 58 patients met our inclusion criteria. The retethering rate in our patient cohort was 5.2% (3/58); one of the three patients developed two episodes of a retethering. Patients with an unchanged conus level, no improvement in the syringomyelia, and an unchanged thickness of the spinal cord postoperatively seem to have a significant higher risk to develop a retethering episode in the follow-up.
Conclusion: Retethering after transection of the filum terminale did occur more often than expected. Certain existing factors on the routine postoperative MR images may help to identify patients with an increased likelihood to develop a retethering episode. These results may contribute to improve the follow-up for patients after transection of a TFT and may facilitate adequate treatment.
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Predictors of postsurgical retethering in pediatric fatty or tight filum terminale: a systematic review and meta-analysis of 1167 patients.
J Neurosurg Pediatr
December 2024
1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Article Synopsis
- The study aimed to profile pediatric patients with tight filum terminale (TFT) or fatty filum terminale (FFT) who experienced retethering after surgery and identify risk factors for this occurrence.
- After reviewing multiple medical databases, eleven studies involving 1167 patients were included, revealing a retethering rate of 3.4%, with lower-extremity weakness and bowel or bladder dysfunction being common symptoms.
- Key predictors for retethering were identified as postoperative cerebrospinal fluid (CSF) leakage and preoperative sensory changes, while having a low-lying conus was not a significant risk factor.
Retethering after transection of a tight filum terminale, postoperative MRI may help to identify patients at risk.
Childs Nerv Syst
July 2020
Department of Pediatric Neurosurgery, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Purpose: Retethering after transection of a tight filum terminale (TFT) deemed to be a rare and usually only years after initial surgery occurring complication. Possible perioperative factors that might influence the retethering rate or help to allow a prognostic risk assessment are still poorly investigated. The aim of this study was to analyze our patient cohort who underwent a TFT transection by assessing clinical outcome, retethering rate, and pre- and postoperative MRI studies.
View Article and Find Full Text PDFFirst Case of Autonomic Dysreflexia Following Elective Lower Thoracic Spinal Cord Transection in a Spina Bifida Adult.
World Neurosurg
December 2017
Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane University, New Orleans, Louisiana, USA. Electronic address:
Background: Spinal cord transection is a radical but effective treatment for highly selective cases of symptomatic spinal retethering in paraplegic spina bifida patients. Autonomic dysreflexia (AD) is a potentially life-threatening syndrome involving a dysregulated sympathetic discharge reflex commonly seen following cervical and high thoracic spinal cord injury, leading to a disconnect between autonomic pathways above and below the lesion that can lead to severe complications including uncontrolled hypertension, bradycardia, stroke, and potentially death. Herein we present a case in which a paraplegic spina bifida patient presenting with symptomatic spinal retethering experienced autonomic dysreflexia following an elective spinal cord transection.
View Article and Find Full Text PDFRetethering of transected fatty filum terminales.
J Neurosurg Pediatr
January 2011
Division of Neurosurgery, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA.
Object: Untethering of a tethered spinal cord (TSC) by transecting or removing a fatty filum terminale is a relatively simple procedure that can prevent or ameliorate neurological symptoms, and the postoperative prognosis is usually good. Progressive neurological deterioration caused by recurrent tethering has been rarely reported. The authors present their experience in cases in which a sectioned fatty filum terminale has become retethered.
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