Symptomatic Retethering of the Spinal Cord After Section of a Tight Filum Terminale

• Published in: Neurosurgery Vol. 68; no. 6; pp. 1594 - 1602
• Main Authors: Yong, Raymund L., Habrock-Bach, Tracey, Vaughan, Mariko, Kestle, John R., Steinbok, Paul
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Oxford University Press 01.06.2011; Lippincott Williams & Wilkins; Wolters Kluwer Health, Inc
• Subjects: Adolescent; Aged, 80 and over; Biological and medical sciences; Cauda Equina - pathology; Cauda Equina - surgery; Child; Child, Preschool; Female; Humans; Infant; Male; Medical sciences; Neural Tube Defects - surgery; Neurosurgery; Neurosurgical Procedures; Recurrence; Reoperation; Retrospective Studies; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Young Adult; Child complications; Filum terminale; Surgery; Tethered cord syndrome; Spina bifida occulta; Human; Spinal cord; Nervous system diseases; Diseases of the osteoarticular system; Spine disease; Congenital disease; Malformation; Complication; Child
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0b013e31821246c6

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.