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Retethering of sectioned fibrolipomatous filum terminales: report of two cases.
Neurosurgery. 1998 Jun; 42(6):1390-3.N

Abstract

OBJECTIVE AND IMPORTANCE

The release of a tethered spinal cord by sectioning a thickened filum terminale is a straightforward surgical procedure that can prevent, arrest, or ameliorate neurological deficits. We recently recognized progressive neurological deterioration caused by filum retethering in two patients years after this procedure was performed. This sequela of a recurrent tethered cord after the sectioning of a filum terminale has not previously been described.

CLINICAL PRESENTATION

Two female patients, each 13 years of age at presentation, had been previously operated on for tethered spinal cords secondary to fibrolipomatous (fatty) fila terminale. Both presented with bladder dysfunction and one with progressive paraparesis. Magnetic resonance images revealed a low-lying conus medullaris and a sectioned filum with the proximal stump adherent to the posterior dura.

INTERVENTION

Each patient underwent neurosurgical exploration of the previous site of sectioning, with the recognition of a retethered proximal stump of the filum terminale. After rerelease of the fatty filum, the patient with only bladder dysfunction stabilized and a motor examination revealed normal results for the patient with progressive paraparesis.

CONCLUSION

Retethering of the spinal cord is a rare sequela after the sectioning of a tight filum terminale. The clinical presentation is typical for recurrent cord tethering, and the radiographic findings are subtle. Careful surgical exploration should be offered for spinal cord untethering. Awareness of this rare and hitherto undescribed sequela is necessary for appropriate long-term management of tethered spinal cord caused by a fatty filum terminale.

Authors+Show Affiliations

Division of Neurosurgery, The New York Hospital/Cornell University Medical College New York, 10021, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

9632203

Citation

Souweidane, M M., and J M. Drake. "Retethering of Sectioned Fibrolipomatous Filum Terminales: Report of Two Cases." Neurosurgery, vol. 42, no. 6, 1998, pp. 1390-3.
Souweidane MM, Drake JM. Retethering of sectioned fibrolipomatous filum terminales: report of two cases. Neurosurgery. 1998;42(6):1390-3.
Souweidane, M. M., & Drake, J. M. (1998). Retethering of sectioned fibrolipomatous filum terminales: report of two cases. Neurosurgery, 42(6), 1390-3.
Souweidane MM, Drake JM. Retethering of Sectioned Fibrolipomatous Filum Terminales: Report of Two Cases. Neurosurgery. 1998;42(6):1390-3. PubMed PMID: 9632203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retethering of sectioned fibrolipomatous filum terminales: report of two cases. AU - Souweidane,M M, AU - Drake,J M, PY - 1998/6/19/pubmed PY - 1998/6/19/medline PY - 1998/6/19/entrez SP - 1390 EP - 3 JF - Neurosurgery JO - Neurosurgery VL - 42 IS - 6 N2 - OBJECTIVE AND IMPORTANCE: The release of a tethered spinal cord by sectioning a thickened filum terminale is a straightforward surgical procedure that can prevent, arrest, or ameliorate neurological deficits. We recently recognized progressive neurological deterioration caused by filum retethering in two patients years after this procedure was performed. This sequela of a recurrent tethered cord after the sectioning of a filum terminale has not previously been described. CLINICAL PRESENTATION: Two female patients, each 13 years of age at presentation, had been previously operated on for tethered spinal cords secondary to fibrolipomatous (fatty) fila terminale. Both presented with bladder dysfunction and one with progressive paraparesis. Magnetic resonance images revealed a low-lying conus medullaris and a sectioned filum with the proximal stump adherent to the posterior dura. INTERVENTION: Each patient underwent neurosurgical exploration of the previous site of sectioning, with the recognition of a retethered proximal stump of the filum terminale. After rerelease of the fatty filum, the patient with only bladder dysfunction stabilized and a motor examination revealed normal results for the patient with progressive paraparesis. CONCLUSION: Retethering of the spinal cord is a rare sequela after the sectioning of a tight filum terminale. The clinical presentation is typical for recurrent cord tethering, and the radiographic findings are subtle. Careful surgical exploration should be offered for spinal cord untethering. Awareness of this rare and hitherto undescribed sequela is necessary for appropriate long-term management of tethered spinal cord caused by a fatty filum terminale. SN - 0148-396X UR - https://www.unboundmedicine.com/medline/citation/9632203/Retethering_of_sectioned_fibrolipomatous_filum_terminales:_report_of_two_cases_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1097/00006123-199806000-00130 DB - PRIME DP - Unbound Medicine ER -