Article
Functional outcome after filum sectioning in occult tethered cord syndrome and fatty filum
Funktionelles Outcome nach Durchtrennung des Filum bei Kindern mit okkultem Tethered Cord Syndrom und Fatty Filum
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Authors
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Stefanie Deininger
- Universitätsklinikum Ulm, Neurochirurgie und Pädiatrische Neurochirurgie, Ulm, Deutschland
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Nicole Angela Terpolilli
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgie, München, Deutschland
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Mathias Kunz
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgie, München, Deutschland
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Marie Schuler-Ortholi
- Universitätsklinikum Ulm, Neurochirurgie und Pädiatrische Neurochirurgie, Ulm, Deutschland
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Aurelia Peraud
- Universitätsklinikum Ulm, Neurochirurgie und Pädiatrische Neurochirurgie, Ulm, Deutschland; Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgie, München, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Minor variants of occult spinal dysraphism comprise the tight filum in occult tethered cord syndrome (OTCS) as well as the thickened or fatty filum (FF). The underlying abnormal tension of the spinal cord can lead to various clinical symptoms such as motor deficits, urological disturbances, and pain, despite relative discrete radiomorphological signs on MR images. The aim of the current study was to highlight clinical scenarios rectifying microsurgical detethering even in almost normal MR images, and to demonstrate postoperative outcome.
Methods: We retrospectively analysed clinical records of pediatric patients who underwent microsurgical filum sectioning for OTCS or FF at the Section of Pediatric Neurosurgery, University of Munich and Ulm between 01/2007 and 11/2019. All children underwent microsurgical detethering under intraoperative electrophysiological monitoring and had multidisciplinary follow-up.
Results: 33 patients (17 male, 16 female) diagnosed for either OTCS (22 patients) or FF (11 patients) were included in the study. Mean age at surgery was 6.0 years (range 0.6–16.8 years). Presenting symptoms consisted in bladder (26, 78.8%) or bowel dysfunction (7, 21.2%; 3 caudal regression syndromes), motor deficits (21, 63.6%), foot deformities (15, 45.5%) and pain (8, 24.2%; leg, back, perineal). In addition to minimal signs of a tethered cord with tight or fatty filum, MR images showed syrinx in 9 and scoliosis in 4 patients. Postoperatively, bladder dysfunction improved in 16/26 (61.5%), bowel problems in 1/7 (14.3%), motor deficits in 14/21 (66.7%), pain in 4/8 (50%), and foot deformities in 1/14 (7.1%) patients. Apart from one superficial wound infection no complications occurred and none of the patients showed any worsening of their symptoms. Median follow-up was 2.3 years.
Conclusion: The results of the present study demonstrate a surprisingly high chance for improvement of bladder and motor deficits as well as pain in patients with either a tight or a fatty filum after sectioning of the filum. The complication rate is low. Thus, the indication for filum sectioning should always be considered in patients with typical symptoms even when MR images show only minimal or no clear signs for tethered cord.
