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Occult tight filum terminale syndrome: results of surgical untethering.
Pediatr Neurosurg. 2004 Mar-Apr; 40(2):51-7; discussion 58.PN

Abstract

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.

Authors+Show Affiliations

Divisions of Pediatric Neurosurgery and Pediatric Urology, Emanuel Children's Hospital, Portland, Oreg., USA. monicawehby@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15292632

Citation

Wehby, Monica C., et al. "Occult Tight Filum Terminale Syndrome: Results of Surgical Untethering." Pediatric Neurosurgery, vol. 40, no. 2, 2004, pp. 51-7; discussion 58.
Wehby MC, O'Hollaren PS, Abtin K, et al. Occult tight filum terminale syndrome: results of surgical untethering. Pediatr Neurosurg. 2004;40(2):51-7; discussion 58.
Wehby, M. C., O'Hollaren, P. S., Abtin, K., Hume, J. L., & Richards, B. J. (2004). Occult tight filum terminale syndrome: results of surgical untethering. Pediatric Neurosurgery, 40(2), 51-7; discussion 58.
Wehby MC, et al. Occult Tight Filum Terminale Syndrome: Results of Surgical Untethering. Pediatr Neurosurg. 2004 Mar-Apr;40(2):51-7; discussion 58. PubMed PMID: 15292632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Occult tight filum terminale syndrome: results of surgical untethering. AU - Wehby,Monica C, AU - O'Hollaren,Patrick S, AU - Abtin,Keyvan, AU - Hume,Jenny L, AU - Richards,Benjamin J, PY - 2004/8/5/pubmed PY - 2005/1/29/medline PY - 2004/8/5/entrez SP - 51-7; discussion 58 JF - Pediatric neurosurgery JO - Pediatr Neurosurg VL - 40 IS - 2 N2 - 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. SN - 1016-2291 UR - https://www.unboundmedicine.com/medline/citation/15292632/Occult_tight_filum_terminale_syndrome:_results_of_surgical_untethering_ L2 - https://www.karger.com?DOI=10.1159/000078908 DB - PRIME DP - Unbound Medicine ER -