Patient-Reported Outcomes Following Sectioning of the Filum Terminale for Treatment of Tethered Cord Syndrome Associated With Ehlers-Danlos Syndrome

• Published in: Curēus (Palo Alto, CA) Vol. 14; no. 5; p. e24679
• Main Authors: Zingman, Alissa, Tuchman, Kelly, Henderson, Fraser, Francomano, Clair A
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 02.05.2022; Cureus
• Subjects: Back pain; Bladder; Connective tissue; Genetics; Neurosurgery; Nocturia; Patient satisfaction; Postoperative period; Rheumatology; Surgery; Surgical outcomes; Urinary tract diseases; Urinary tract infections; Urogenital system; Variables; hypermobility disorder; ehlers danlos syndrome; back pain; tethered cord syndrome; filum terminale
• DOI: 10.7759/cureus.24679
• ISSN: 2168-8184

Introduction Tethered cord syndrome (TCS) was first reported as a potential complication of Ehlers-Danlos Syndrome in 2009. However, there have been few publications on the subject since that time, and optimal treatment of TCS in the setting of the hypermobile Ehlers-Danlos Syndrome (hEDS) population remains unknown. The purpose of this study was to determine the safety and efficacy of surgical release of the filum terminale (FT) for the treatment of TCS in this patient population. Methods We performed a retrospective chart review of consecutive hEDS patients with TCS who were treated with surgical release after providing informed surgical consent over a 4.5-year period by a single neurosurgeon. Eighty-four patients were identified and asked to complete surveys with items regarding pre and postoperative symptoms, pain levels, and satisfaction. Results Thirty patients with a mean age of 30.8 ± 11.9 years, all female, were included. Low back pain was significantly improved across the entire cohort. For patients with both pre and postoperative data available, the distance they were able to walk also improved significantly. The majority of patients were "highly satisfied" with surgery (66%), followed by 21% "satisfied", 10% "neutral", and one patient who was "dissatisfied". One patient required repair of a dural leak one week postoperatively, and no other complications were noted. Conclusions Surgical release of the FT for TCS in patients with hEDS was safe and effective in this cohort. For most patients, there was a significant improvement in low back pain, urinary symptoms, and ability to ambulate distance. The majority of respondents reported subjective satisfaction with this operation. A further prospective study is warranted.