Gross and microscopic study of the filum terminale: does the filum contain functional neural elements?

Gaddam, Samson Sujit Kumar; Santhi, Vissa; Babu, Srinivasa; Chacko, Geeta; Baddukonda, Ramakrishna Appala; Rajshekhar, Vedantam

doi:10.3171/2011.10.peds11102

Cited by 20 publications

(15 citation statements)

References 27 publications

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“…Various studies have demonstrated abundance of collagen and elastic fibres, as well as undifferentiated, progenitor cells or multipotent precursors, explaining, according to some authors, the occurrence of ependymal tumours or teratoma at that level [14][15][16]. In particular Tubbs et al [17] described the presence of smooth muscle, nerve, bone, cartilage and adipose tissue in samples from cadaveric filum externa.…”

Section: Discussionmentioning

confidence: 99%

Calcium pyrophosphate dihydrate deposition disease of the filum terminale

2013

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Introduction Calcium pyrophosphate dihydrate crystal deposition disease (CPPDD) is a rare benign inflammatory joint disorder characterized by the presence of calcium pyrophosphate dihydrate crystal in the interarticular and periarticular tissue. It has been rarely described with spinal localization. Methods A 50-year-old woman, affected by CPPDD, presented a progressive weakness of both lower limbs associated with neurogenic claudication. Neuroradiological examinations revealed the presence of two intradural calcified lesions at level L3-L4, with no post-contrast enhancement.Results Surgery was performed and the histopathological exams documented the presence of rod-shaped crystals embedded in a fibrocartilaginous stroma. The postoperative course was uneventful and the patient experienced complete symptoms relief with a 5-year follow-up. Conclusion Intradural CPPD localization at the filum terminale is an extremely rare occurrence. Total removal should be preferably attempted with a long-term focal control of the disease as we observed in our case.

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Section: Discussionmentioning

confidence: 99%

Calcium pyrophosphate dihydrate deposition disease of the filum terminale

2013

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“…Gaddam et al [5] found the following 2 types of spinal nerve roots in and along the filum in stillborn cadavers (36 weeks): (1) a nerve traversing within the filum terminale and (2) a nerve attaching to and running along the filum. Kural et al [6] also reported demyelinated nerve fascicles with epineurium and ganglion cells in 34% of 14- to 35-week fetal specimens.…”

Section: Discussionmentioning

confidence: 99%

“…For this to be the case, conversely, a remnant of neural cells is likely to persist into later development and growth. However, the classical connection between secondary neurulation and the filum terminale has not been discussed in recent embryological studies by clinical neurologists, even those focused on caudal neural tube syndromes [5,6,7]. The first aim of this study, therefore, was to revisit the link between secondary neurulation and the filum terminale during fetal development.…”

Section: Introductionmentioning

confidence: 99%

The Filum Terminale Revisited: A Histological Study in Human Fetuses

Jang

Cho²,

Chang³

et al. 2015

Pediatr Neurosurg

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Previous studies have suggested that secondary neurulation provides no functional neurons but only the filum terminale. However, no studies have confirmed that the coccygeal and lower sacral nerves do not originate from the secondary neural tube but only from the primary tube. To obtain a better understanding of these relationships, we examined sagittal or frontal sections from 20 embryonic and fetal specimens ranging from 6 to 14 weeks of gestation. During the growth of the vertebral column as well as the subsequent upward migration of the caudal end of the dural sac, the secondary neural tube was stretched to maintain the original attachment to the coccyx or the lower sacral vertebra. The filum-like structure showed much individual variability but in all cases appeared to be derived from the stretched neural tube. Intermediate age morphology revealed that the secondary neural tube itself provided an initial filum terminale before the ascent of the dural sac. Given that the coccygeal and lower sacral nerves are likely to originate from the secondary neural tube, these parts of the tube persisted and differentiated into spinal neurons to form the anococcygeal nerves. Likewise, the filum terminale was also most likely to contain some neurons that persisted postnatally. Depending on the timing and site of degeneration of the secondary neural tube, individual variations could occur in proportion to the amount of sensory and motor elements in the anococcygeal nerve supply.

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“…LPs at T12-L1 are too risky to recommend on a routine basis, because a substantial part of the CM would be present within the LP window, even upon adoption of the LDP. As the FT can contain neuronal tissue (Gaddam et al, 2012), we also considered positional shifts of the FT at these three disc levels to evaluate the theoretical risk of its injury if a high LP were to be considered. We found that in hypothetical cases where the CM terminates at a high level, and where the FT might be positioned at the three disc levels under consideration, all theoretical LPs would be safe because the FT is thin and it would also shift sufficiently away from the midsagittal plane upon adoption of the LDP (Tables 5 and 6).…”

Section: Positional Shifts Of the CMmentioning

confidence: 99%

Are high lumbar punctures safe? A magnetic resonance imaging morphometric study of the conus medullaris

et al. 2019

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A high lumbar puncture (LP) at L2–L3 or above is often necessary to consider on technical grounds, but complications of conus medullaris (CM) damage during high LP are potentially concerning. We hypothesized that a high LP might be safer than previously thought by accounting for movements of the CM upon patient positional changes. We retrospectively reviewed standard normal supine lumbar spine magnetic resonance imaging of 58 patients and used electronic calipers on axial images at the T12–L1, L1–L2, and L2–L3 disc levels to measure the transverse diameter of the CM relative to the size of the dorsal thecal sac space (DTSS) through which a spinal needle could be inserted. On 142 axial images, the means for CM diameters were 8.2, 6.0, and 2.9 mm at the three levels, respectively. We then used known literature mean CM displacement values in the legs flexed and unflexed lateral decubitus position (LDP) to factor in CM shifts to the dependent side. We found that at all three levels, the likely positional shift of the CM would be too small and insufficient to displace the entire CM out of the DTSS. However, if needle placement could be confined to the midsagittal plane, an LP in the unflexed LDP would theoretically be entirely safe at both L1–L2 and L2–L3, and almost so at L2–L3 in the legs flexed LDP. Thus, high LPs at L1–L2 and L2–L3 are in theory likely safer than considered previously, more so in the legs unflexed than in the flexed LDP. Clin. Anat. 32:618–629, 2019. © 2019 Wiley Periodicals, Inc.

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Gross and microscopic study of the filum terminale: does the filum contain functional neural elements?

Cited by 20 publications

References 27 publications

Calcium pyrophosphate dihydrate deposition disease of the filum terminale

Calcium pyrophosphate dihydrate deposition disease of the filum terminale

The Filum Terminale Revisited: A Histological Study in Human Fetuses

Are high lumbar punctures safe? A magnetic resonance imaging morphometric study of the conus medullaris

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