Minimally Invasive Surgical Approach to Filum Lipoma

Abstract

Filum terminale lipoma (FTL) causes various spinal symptoms known as tethered cord syndrome. The treatment for FTL is surgical untethering by sectioning the FTL, which can prevent symptom progression and often results in improvement of symptoms. This report describes a minimally invasive surgical strategy that we have introduced for FTL sectioning. The pediatric patients with FTL since 2007 were treated using this minimally invasive surgical strategy, which we refer to as an interlaminar approach (ILA). In summary, the surgical technique involves: minimal skin incision to expose the unilateral ligamentum flavum in the lower lumbar region; ligamentum flavum incision to expose the dural sac, and dural incision followed by identification and sectioning of the filum. Postoperatively, no bed rest was required. Prior to introducing ILA, we had used standard one level laminectomy/laminotomy (LL) with more than 1 week of postsurgical bed rest until 2007, providing an adequate control group for the benefit of the ILA. A total of 49 consecutive patients were treated using ILA. While 37 patients were treated using LL. Surgical complications that need surgery were seen only in one patient, who developed cerebrospinal fluid (CSF) leak in LL patients. No retethering or additional neurological symptoms were seen during follow-up. All patients complained of minimal postsurgical back pain, but no patients required postoperative bed rest in ILA patients, while LL patients need postsurgical bed rest because of back pain. The ILA strategy provides the advantage of a minimal tissue injury, associated with minimal postoperative pain, blood loss, and bed rest.

Double neurophysiological certification of the filum terminale during sectioning surgery in pediatric population

“…The FT sectioning surgery is currently rapidly evolving in a tailored surgical field. [ 1 ] This may result in inappropriate stimulation as a result of current propagation, which could cause confusion in taking the final surgical decision despite a clear anatomical appearance of the FT.…”

“…[ 2 ] At present, this is one of the simplest surgeries for tethered cord which can be performed more quickly and in a perfectly tailored surgical field. [ 1 ] However, in some cases, there is a positive mapping response with low intensity stimulation of the FT,[ 6 ] affected by an individual threshold variability of motor rootlets in pediatric population. The aim of this study is to demonstrate the usefulness of a double methodology for FT certification.…”

Determining the optimal timing of screening spinal cord ultrasonography to detect filum terminale lipoma in infants

“…Occult tethered cord syndrome from a thickened filum was recently proposed, but this possibility has yet to be thoroughly investigated [ 5 ]. Even though no consensus exists regarding the treatment of filum terminale lipoma, recent studies have demonstrated that the risk of neurological impairment in pediatric patients with filum terminale lipoma was higher than in adults, and early surgical detethering may prevent possible irreversible neurological deficits [ 5 , 11 , 19 , 22 - 24 ]. Consequently, we propose that the early detection of filum terminale lipoma is important, particularly for screening purposes in pediatric patients.…”

Comparison of the Inter-laminar Approach and Laminotomy Open Approach for Filum Terminale Lipoma: A Retrospective Analysis

“…Despite recommendations for prophylactic surgery, this intervention is controversial [13,33]. The standard surgical procedure for FTL is laminotomy-based dissection [9]; however, less-invasive techniques have been reported [8,10,22].…”