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Tethered Cord Syndrome Caused by Duplicated Filum Terminale in an Adult with Split Cord Malformation.
World Neurosurg. 2020 11; 143:7-10.WN

Abstract

BACKGROUND

Tethered cord syndrome (TCS) is a clinical diagnosis of progressive neurologic aggravation of the lower spinal cord due to a traction on the conus medullaris. Untethering surgery is effective for most TCS; however, when anatomic variations of spinal cord and filum terminale (FT) exist, regular untethering may lead to a failed outcome.

CASE DESCRIPTION

The authors present the case of a 45-year-old patient with TCS caused by duplicated FT with split cord malformation (SCM). Lumbosacral magnetic resonance imaging revealed a type II SCM with a significant low-lying conus medullaris. Laminectomy was performed. Neurophysiologic monitoring was used for nerve root identification and 2 thickened fila, which failed to respond on stimulation, were found during the surgery. Both fila were sectioned, and the diagnosis was finally confirmed by pathologic examination. Postoperatively, the patient's symptoms disappeared immediately and no neurologic sequela was found after surgery.

CONCLUSIONS

This is the first documented adult of duplicated FT with preoperative radiologic evidence and reported in association with SCM as a cause of TCS. When SCM exists, a careful observation for duplicated FT is warranted on preoperative magnetic resonance imaging and during surgery. Complete transection of the double FT under intraoperative neurophysiologic monitoring is the best treatment for this anomaly.

Authors+Show Affiliations

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, Beijing, P.R. China; Department of Neurosurgery, Peking University First Hospital, Beijing, P.R. China.Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, Beijing, P.R. China.Department of Neurosurgery, Peking University First Hospital, Beijing, P.R. China.Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, Beijing, P.R. China.Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, Beijing, P.R. China. Electronic address: neurospinejfz@163.com.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32711136

Citation

Xu, Feifan, et al. "Tethered Cord Syndrome Caused By Duplicated Filum Terminale in an Adult With Split Cord Malformation." World Neurosurgery, vol. 143, 2020, pp. 7-10.
Xu F, Wang X, Li L, et al. Tethered Cord Syndrome Caused by Duplicated Filum Terminale in an Adult with Split Cord Malformation. World Neurosurg. 2020;143:7-10.
Xu, F., Wang, X., Li, L., Guan, J., & Jian, F. (2020). Tethered Cord Syndrome Caused by Duplicated Filum Terminale in an Adult with Split Cord Malformation. World Neurosurgery, 143, 7-10. https://doi.org/10.1016/j.wneu.2020.07.100
Xu F, et al. Tethered Cord Syndrome Caused By Duplicated Filum Terminale in an Adult With Split Cord Malformation. World Neurosurg. 2020;143:7-10. PubMed PMID: 32711136.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tethered Cord Syndrome Caused by Duplicated Filum Terminale in an Adult with Split Cord Malformation. AU - Xu,Feifan, AU - Wang,Xingwen, AU - Li,Liang, AU - Guan,Jian, AU - Jian,Fengzeng, Y1 - 2020/07/22/ PY - 2020/06/30/received PY - 2020/07/15/revised PY - 2020/07/17/accepted PY - 2020/7/28/pubmed PY - 2021/4/20/medline PY - 2020/7/26/entrez KW - Conus medullaris KW - Filum terminale KW - Spinal cord KW - Split cord malformation KW - Tethered cord syndrome SP - 7 EP - 10 JF - World neurosurgery JO - World Neurosurg VL - 143 N2 - BACKGROUND: Tethered cord syndrome (TCS) is a clinical diagnosis of progressive neurologic aggravation of the lower spinal cord due to a traction on the conus medullaris. Untethering surgery is effective for most TCS; however, when anatomic variations of spinal cord and filum terminale (FT) exist, regular untethering may lead to a failed outcome. CASE DESCRIPTION: The authors present the case of a 45-year-old patient with TCS caused by duplicated FT with split cord malformation (SCM). Lumbosacral magnetic resonance imaging revealed a type II SCM with a significant low-lying conus medullaris. Laminectomy was performed. Neurophysiologic monitoring was used for nerve root identification and 2 thickened fila, which failed to respond on stimulation, were found during the surgery. Both fila were sectioned, and the diagnosis was finally confirmed by pathologic examination. Postoperatively, the patient's symptoms disappeared immediately and no neurologic sequela was found after surgery. CONCLUSIONS: This is the first documented adult of duplicated FT with preoperative radiologic evidence and reported in association with SCM as a cause of TCS. When SCM exists, a careful observation for duplicated FT is warranted on preoperative magnetic resonance imaging and during surgery. Complete transection of the double FT under intraoperative neurophysiologic monitoring is the best treatment for this anomaly. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/32711136/Tethered_Cord_Syndrome_Caused_by_Duplicated_Filum_Terminale_in_an_Adult_with_Split_Cord_Malformation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(20)31621-1 DB - PRIME DP - Unbound Medicine ER -