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Symptomatic retethering of the spinal cord after section of a tight filum terminale.
Neurosurgery. 2011 Jun; 68(6):1594-601; discussion 1601-2.N

Abstract

BACKGROUND

Section of a tight filum terminale is a minimally invasive procedure compared with cord untethering procedures used for more complex spinal abnormalities. Anecdotal evidence suggests, however, that the risk of symptomatic retethering resulting from scarring might be higher than previously thought.

OBJECTIVE

To determine the frequency of symptomatic retethering after section of a tight filum terminale and to explore possible risk factors.

METHODS

We reviewed databases at 2 pediatric neurosurgery centers for all patients who had surgery for a suspected tight filum terminale between January 1982 and June 2009.

RESULTS

We identified 152 patients. The median length of follow-up was 78 months. Thirteen patients (8.6%) went on to retether symptomatically at a median time of 23.4 months after the initial procedure. Eight had early retethering (within 2 years) and 5 had late retethering (after 7 years). Compared with late retetherers, early retetherers were older at initial surgery (median, 9.4 vs 0.9 years of age), had a higher level of the conus (median, L1/L2 vs L3/L4), had more arachnoiditis after initial surgery, and required more repeat untethering procedures. Late retetherers were younger at initial surgery than those who did not retether (median, 0.9 vs 4.5 years of age).

CONCLUSION

Symptomatic retethering is not uncommon after a simple filum snip, and long-term follow-up is warranted. Two distinct patterns of retethering were observed. Arachnoiditis caused by infection or a cerebrospinal fluid fistula may predispose to early retethering, whereas early surgery for prevention of tethered cord symptoms may predispose to late retethering.

Authors+Show Affiliations

Division of Pediatric Neurosurgery, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21346653

Citation

Yong, Raymund L., et al. "Symptomatic Retethering of the Spinal Cord After Section of a Tight Filum Terminale." Neurosurgery, vol. 68, no. 6, 2011, pp. 1594-601; discussion 1601-2.
Yong RL, Habrock-Bach T, Vaughan M, et al. Symptomatic retethering of the spinal cord after section of a tight filum terminale. Neurosurgery. 2011;68(6):1594-601; discussion 1601-2.
Yong, R. L., Habrock-Bach, T., Vaughan, M., Kestle, J. R., & Steinbok, P. (2011). Symptomatic retethering of the spinal cord after section of a tight filum terminale. Neurosurgery, 68(6), 1594-601; discussion 1601-2. https://doi.org/10.1227/NEU.0b013e31821246c6
Yong RL, et al. Symptomatic Retethering of the Spinal Cord After Section of a Tight Filum Terminale. Neurosurgery. 2011;68(6):1594-601; discussion 1601-2. PubMed PMID: 21346653.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptomatic retethering of the spinal cord after section of a tight filum terminale. AU - Yong,Raymund L, AU - Habrock-Bach,Tracey, AU - Vaughan,Mariko, AU - Kestle,John R, AU - Steinbok,Paul, PY - 2011/2/25/entrez PY - 2011/2/25/pubmed PY - 2011/12/13/medline SP - 1594-601; discussion 1601-2 JF - Neurosurgery JO - Neurosurgery VL - 68 IS - 6 N2 - BACKGROUND: Section of a tight filum terminale is a minimally invasive procedure compared with cord untethering procedures used for more complex spinal abnormalities. Anecdotal evidence suggests, however, that the risk of symptomatic retethering resulting from scarring might be higher than previously thought. OBJECTIVE: To determine the frequency of symptomatic retethering after section of a tight filum terminale and to explore possible risk factors. METHODS: We reviewed databases at 2 pediatric neurosurgery centers for all patients who had surgery for a suspected tight filum terminale between January 1982 and June 2009. RESULTS: We identified 152 patients. The median length of follow-up was 78 months. Thirteen patients (8.6%) went on to retether symptomatically at a median time of 23.4 months after the initial procedure. Eight had early retethering (within 2 years) and 5 had late retethering (after 7 years). Compared with late retetherers, early retetherers were older at initial surgery (median, 9.4 vs 0.9 years of age), had a higher level of the conus (median, L1/L2 vs L3/L4), had more arachnoiditis after initial surgery, and required more repeat untethering procedures. Late retetherers were younger at initial surgery than those who did not retether (median, 0.9 vs 4.5 years of age). CONCLUSION: Symptomatic retethering is not uncommon after a simple filum snip, and long-term follow-up is warranted. Two distinct patterns of retethering were observed. Arachnoiditis caused by infection or a cerebrospinal fluid fistula may predispose to early retethering, whereas early surgery for prevention of tethered cord symptoms may predispose to late retethering. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/21346653/Symptomatic_retethering_of_the_spinal_cord_after_section_of_a_tight_filum_terminale_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0b013e31821246c6 DB - PRIME DP - Unbound Medicine ER -