Section of the filum terminale: is it worthwhile in Chiari type I malformation?

Massimi, Luca; Peraio, Simone; Peppucci, Elisabetta; Tamburrini, Gianpiero; Rocco, Concezio Di

doi:10.1007/s10072-011-0691-4

Cited by 30 publications

(21 citation statements)

References 14 publications

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“…12,28,36 Another group has found no correlation between tethered cord and CM-I. 25 After efforts to exclude CM-II patients with myelomeningocele, we found a small number of patients who had undergone a spinal cord untethering operation in addition to CMD. Although the overall numbers were small and the difference was not statistically significant, there was a trend toward an increasing frequency of untethering procedures, with 6 performed in the first half of the study period compared with 17 in the second half.…”

Section: Tethered Cordmentioning

confidence: 79%

Trends in surgical treatment of Chiari malformation Type I in the United States

Wilkinson¹,

Johnson²,

Garton³

et al. 2017

PED

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OBJECTIVE The goal of this analysis was to define temporal and geographic trends in the surgical treatment of Chiari malformation Type I (CM-I) in a large, privately insured health care network. METHODS The authors examined de-identified insurance claims data from a large, privately insured health care network of over 58 million beneficiaries throughout the United States for the period between 2001 and 2014 for all patients undergoing surgical treatment of CM-I. Using a combination of International Classification of Diseases (ICD) diagnosis codes and Current Procedural Terminology (CPT) codes, the authors identified CM-I and associated diagnoses and procedures over a 14-year period, highlighting temporal and geographic trends in the performance of CM-I decompression (CMD) surgery as well as commonly associated procedures. RESULTS There were 2434 surgical procedures performed for CMD among the beneficiaries during the 14-year interval; 34% were performed in patients younger than 20 years of age. The rate of CMD increased 51% from the first half to the second half of the study period among younger patients (p < 0.001) and increased 28% among adult patients between 20 and 65 years of age (p < 0.001). A large sex difference was noted among adult patients; 78% of adult patients undergoing CMD were female compared with only 53% of the children. Pediatric patients undergoing CMD were more likely to be white with a higher household net worth. Regional variability was identified among rates of CMD as well. The average annual rate of surgery ranged from 0.8 surgeries per 100,000 insured person-years in the Pacific census division to 2.0 surgeries per 100,000 insured person-years in the East South Central census division. CONCLUSIONS Analysis of a large nationwide health care network showed recently increasing rates of CMD in children and adults over the past 14 years.

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Section: Tethered Cordmentioning

confidence: 79%

Trends in surgical treatment of Chiari malformation Type I in the United States

Wilkinson¹,

Johnson²,

Garton³

et al. 2017

PED

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“…Alterations in this anchoring can increase tension on the caudal spinal cord with clinical consequences, so‐called tethered cord syndrome (TCS) in people . There is an association among a subset of CM1 patients, as well as those suffering from SM, with TCS . To date, the relationship between Chiari malformations, syringomyelia (CMSM) and TCS has not been explored in dogs; although, a recent study using a 3‐dimensional computer model suggested tethering as a potential mechanism for SM development within the canine spinal cord …”

Section: Introductionmentioning

confidence: 99%

Morphometric analysis of spinal cord termination in Cavalier King Charles Spaniels

Sparks

Robertson

Olby

2019

Veterinary Internal Medicne

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Background There is an association between Chiari malformations, syringomyelia (CMSM) and tethered cord syndrome (TCS) in people, suggesting Cavalier King Charles Spaniels (CKCS) with CMSM could also have TCS. Currently there are no data on the position of the caudal spinal cord structures in CKCS. Objective To describe and compare location of spinal cord termination in CKCS with weight‐matched controls and to examine the relationship between SM and spinal cord termination. Animals Thirty‐nine CKCS and 33 controls with thoracolumbar MRIs; 34 of 39 CKCS also had cervical MRIs. Methods Blinded retrospective study. Spinal cord and dural sac termination were determined from T2‐weighted sagittal and transverse images and half‐Fourier acquisition single‐shot turbo spin echo sequences. Intra‐observer reliability was determined using kappa analysis. Presence of SM was compared with location of spinal cord and dural sac termination. Results Intra‐observer reliability was moderate for identifying spinal cord termination (Kappa = 0.6) and good for dural sac termination (Kappa = 0.8). The spinal cord terminated at lumbar vertebra 6 (L6) in 1, 7 (L7) in 22, and sacrum in 16 CKCS versus 9 at L6, 23 at L7, 1 at sacrum in controls. Spinal cord (P < .001) and dural sac (P = .002) termination were significantly more caudal in CKCS compared to controls. The presence of thoracolumbar SM was associated with more caudal dural sac termination in CKCS (P = .03). Conclusions and Clinical Importance The relationship between TL SM and possible spinal cord tethering because of a more caudal dural sac termination should be investigated.

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“…While Milhorat et al have suggested there may be a link between a Chiari I malformation and tethered cord, 9 several studies have suggested against such an association. [10][11][12] Thereby, the authors attribute the dry lumbar thecal sac to chronic CSF over-drainage.…”

Section: Resultsmentioning

confidence: 99%