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Management of tight filum terminale syndrome with special emphasis on normal level conus medullaris (NLCM).
Surg Neurol. 1998 Oct; 50(4):318-22; discussion 322.SN

Abstract

BACKGROUND

Tethered cord syndrome is classically defined as having the tip of the conus medullaris below the body of L2, instead of at the normal L1-2 disc space level. The syndrome presents most commonly with urinary incontinence. In a patient with urinary incontinence and a low-lying conus medullaris, tethered cord syndrome can be diagnosed without difficulty. However, in a patient with urinary incontinence and a hyperreflexive type of neurogenic bladder, in whom the conus medullaris is found to be at the normal level on magnetic resonance imaging, diagnosing a tethered cord can be challenging. We hypothesized that patients with hyperreflexive neurogenic bladders have a neurologic basis for their bladder dysfunction, probably secondary to tethering by a tight filum terminale, despite having a normally positioned conus medullaris.

METHODS

We investigated 13 patients with tethered cord syndrome with urinary incontinence. All patients underwent urodynamic tests, somatosensory-evoked potentials (SSEPs), and magnetic resonance imaging. All had normal neurologic exams including lower extremity motor, sensory, and reflex functions. To minimize disturbance of the normal anatomy, we used a flavotomy approach and transected the tight filum terminale to release the tethered conus medullaris.

RESULTS

We show that urodynamic studies appear to be more predictive of a tight filum terminale than SSEPs. However, pathological SSEP results seem to correlate with poor surgical outcomes. Ninety-three percent of operated patients were continent by the first post-surgical day. However, disappointingly, almost half lost continence within the first month after surgery.

CONCLUSION

In cases of incontinence with a normal level conus medullaris, but urodynamic studies showing a hyperreflexic neurogenic bladder, we believe that sectioning of the filum terminale often improves continence.

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Authors+Show Affiliations

Selçuki M
University of Ankara, School of Medicine, Department of Neurosurgery, Turkey.
Coşkun K
No affiliation info available

MeSH

AdolescentCauda EquinaChildChild, PreschoolElectromyographyEvoked Potentials, SomatosensoryFemaleHumansMagnetic Resonance ImagingMaleSpina Bifida OccultaUrinary IncontinenceUrodynamics

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9817453

Citation

Selçuki, M, and K Coşkun. "Management of Tight Filum Terminale Syndrome With Special Emphasis On Normal Level Conus Medullaris (NLCM)." Surgical Neurology, vol. 50, no. 4, 1998, pp. 318-22; discussion 322.
Selçuki M, Coşkun K. Management of tight filum terminale syndrome with special emphasis on normal level conus medullaris (NLCM). Surg Neurol. 1998;50(4):318-22; discussion 322.
Selçuki, M., & Coşkun, K. (1998). Management of tight filum terminale syndrome with special emphasis on normal level conus medullaris (NLCM). Surgical Neurology, 50(4), 318-22; discussion 322.
Selçuki M, Coşkun K. Management of Tight Filum Terminale Syndrome With Special Emphasis On Normal Level Conus Medullaris (NLCM). Surg Neurol. 1998;50(4):318-22; discussion 322. PubMed PMID: 9817453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of tight filum terminale syndrome with special emphasis on normal level conus medullaris (NLCM). AU - Selçuki,M, AU - Coşkun,K, PY - 1998/11/17/pubmed PY - 1998/11/17/medline PY - 1998/11/17/entrez SP - 318-22; discussion 322 JF - Surgical neurology JO - Surg Neurol VL - 50 IS - 4 N2 - BACKGROUND: Tethered cord syndrome is classically defined as having the tip of the conus medullaris below the body of L2, instead of at the normal L1-2 disc space level. The syndrome presents most commonly with urinary incontinence. In a patient with urinary incontinence and a low-lying conus medullaris, tethered cord syndrome can be diagnosed without difficulty. However, in a patient with urinary incontinence and a hyperreflexive type of neurogenic bladder, in whom the conus medullaris is found to be at the normal level on magnetic resonance imaging, diagnosing a tethered cord can be challenging. We hypothesized that patients with hyperreflexive neurogenic bladders have a neurologic basis for their bladder dysfunction, probably secondary to tethering by a tight filum terminale, despite having a normally positioned conus medullaris. METHODS: We investigated 13 patients with tethered cord syndrome with urinary incontinence. All patients underwent urodynamic tests, somatosensory-evoked potentials (SSEPs), and magnetic resonance imaging. All had normal neurologic exams including lower extremity motor, sensory, and reflex functions. To minimize disturbance of the normal anatomy, we used a flavotomy approach and transected the tight filum terminale to release the tethered conus medullaris. RESULTS: We show that urodynamic studies appear to be more predictive of a tight filum terminale than SSEPs. However, pathological SSEP results seem to correlate with poor surgical outcomes. Ninety-three percent of operated patients were continent by the first post-surgical day. However, disappointingly, almost half lost continence within the first month after surgery. CONCLUSION: In cases of incontinence with a normal level conus medullaris, but urodynamic studies showing a hyperreflexic neurogenic bladder, we believe that sectioning of the filum terminale often improves continence. SN - 0090-3019 UR - https://www.unboundmedicine.com/medline/citation/9817453/Management_of_tight_filum_terminale_syndrome_with_special_emphasis_on_normal_level_conus_medullaris__NLCM__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090301997003777 DB - PRIME DP - Unbound Medicine ER -