Transhiatal Approach to Filum Terminale Externum Sectioning in Adult Patient With Tethered Cord Syndrome: Case Report

Veronesi, Vanni; Sacco, Carlo; Mastronicola, Cristina; Staffa, Guido

doi:10.1093/ons/opx188

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…The filum terminale externum tethers the thecal sac distally to the sacrococcygeal region (Fig 6). This structure could be a source of traction on or irritation of the thecal sac with an angulated coccyx or coccygeal injury and may be transected to treat a tethered cord (10). The anococcygeal ligament tethers the tip of the coccyx to the anus.…”

Section: Attachmentsmentioning

confidence: 99%

Imaging Coccygeal Trauma and Coccydynia

et al. 2020

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The coccygeal region has complex anatomy, much of which may contribute to or be the cause of coccyx region pain (coccydynia). This anatomy is well depicted at imaging, and management is often dictated by what structures are involved. Coccydynia is a common condition that is known to be difficult to evaluate and treat. However, imaging can aid in determining potential causes of pain to help guide management. Commonly, coccydynia (coccygodynia) occurs after trauma and appears with normal imaging features at static neutral radiography, but dynamic imaging with standing and seated lateral radiography may reveal pathologic coccygeal motion that is predictive of pain. In addition, several findings seen at cross-sectional imaging in patients with coccydynia can point to a source of pain that may be subtle and easily overlooked. Radiology can also offer a role in management of coccygeal region pain with image-guided pain management procedures such as ganglion impar block. In addition to mechanical coccyx pain, a host of other conditions involving the sacrococcygeal region may cause coccydynia, which are well depicted at imaging. These include neoplasm, infection, crystal deposition, and cystic formations such as pilonidal cyst. The authors review a variety of coccydynia causes, their respective imaging features, and common management strategies. ©

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Section: Attachmentsmentioning

confidence: 99%

Imaging Coccygeal Trauma and Coccydynia

et al. 2020

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“… 5 – 7) Surgical approach through sacral hiatus without using laminectomy was also reported for adult patients. 8 , 9) For pediatric patients, Di et al reported endoscopic surgical technique via hemilaminectomy. 4) These procedures have an advantage of reduced soft tissue injury, minimal blood loss, and smaller skin incision.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Surgical Approach to Filum Lipoma

Hayashi

Kimiwada

Kohama

et al. 2018

Neurol. Med. Chir.(Tokyo)

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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.

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“…The same surgeon (VV) performed all procedures. The previously described surgical technique was performed [6]. The only variation is that sacral X-ray fluoroscopy was not performed.…”

Section: Case Reportsmentioning

confidence: 99%

“…In all cases, by performing filum terminale externum (FTE) sectioning, urinary incontinence and signs of hind limb weakness disappeared or were functionally recovered. In one case, an adult patient with TCS was treated with a transhiatal approach to FTE sectioning with excellent results [6]. We describe for the first time the association between lumbar MRI in the prone position and FTE sectioning in OTCS.…”

Section: Introductionmentioning

confidence: 99%

Prone Position Magnetic Resonance Imaging and Transhiatal Approach to Filum Terminale Externum Sectioning in Adolescents with Occult Tethered Cord Syndrome: Report of Four Cases

et al. 2020

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Introduction: Occult tethered cord syndrome (OTCS) and its surgical treatment are controversial. A previous study with lumbar magnetic resonance imaging (MRI) in the prone position had found statistically significant differences in morphological parameters between pediatric OTCS patients and a control group. Filum terminale internum (FTI) sectioning is currently the gold standard for the treatment of OTCS. Case Presentation: We present four cases of adolescents with OTCS, of which three cases were associated with low-lying cerebellar tonsils (LLCT). The patients presented various symptoms of OTCS from pain to sensory disturbances to alterations in sphincter functions, but none had disorders belonging to all three categories. A T2-weighted axial MRI in the prone position supported the clinical diagnosis of OTCS. The patients were treated with minimal skin incision and filum terminale externum (FTE) sectioning through the sacral hiatus under local anesthesia. Discussion: We describe for the first time the association between lumbar MRI in the prone position and FTE sectioning in OTCS. The FTE sectioning has resulted in the disappearance of the pain and sensory disturbance symptoms. The results on the sphincter function are mixed. Three of our four patients with OTCS had LLCT, and all three also reported headache episodes, which, surprisingly, disappeared postoperatively. This minimally invasive surgery involves only minimal discomfort for the patient and minimizes the risks related to skin incision only. The postoperative lumbar MRI in the prone position has shown that there is no mobilization of the FTI or changes in the other preoperative morphological parameters.

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Transhiatal Approach to Filum Terminale Externum Sectioning in Adult Patient With Tethered Cord Syndrome: Case Report

Abstract: After a 6-mo follow-up period, the patient no longer had dysesthesia and pain in his legs, and was able to walk, albeit just a few meters. This surgical technique has the advantage of minimally invasive spine surgery, has few complications, and avoids risk of retethering.

Cited by 6 publications

References 14 publications

Imaging Coccygeal Trauma and Coccydynia

Imaging Coccygeal Trauma and Coccydynia

Minimally Invasive Surgical Approach to Filum Lipoma

Prone Position Magnetic Resonance Imaging and Transhiatal Approach to Filum Terminale Externum Sectioning in Adolescents with Occult Tethered Cord Syndrome: Report of Four Cases

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