1. What is the most likely diagnosis?
2. What test might be useful for establishing a baseline to compare pre- and post-treatment?
4. Which of the following describes you?
5. I practice in one of the following locations.
Fatty infiltration of the filum terminale - “fatty filum” – is a congenital condition that can lead to traction on the spinal cord, clinically manifest as tethered cord syndrome. While general autopsy studies have discovered fatty infiltration of the filum in approximately 5% of the population, the vast majority remain undetected throughout life and only a very small percentage of these end up requiring surgery. Typically, fatty fila are discovered secondary to a dedicated evaluation triggered by characteristic physical findings (midline spine dermal sinus tract or dimple, focal spinal hirsutism or hemangioma) or the development of symptoms suggestive of spinal cord tethering (incontinence, constipation, scoliosis, foot/leg deformity, hamstring tightness/gait or toe walking problems). Once suspected, MRI is useful to identify the presence or absence of a fatty filum. Urodynamics – looking for hyperreflexia, areflexia or loss of synergistic sphincter function – can be helpful as a functional test to help in the diagnosis or exclusion of tethered cord syndrome, and can also serve as a baseline to compare pre- and post- surgery. Indications for surgery remain controversial in asymptomatic cases, but when clear correlation with symptoms are present, then untethering is often warranted.
Features of the lumbar spine on magnetic resonance images following sectioning of filum terminale.
Kim AH, Kasliwal MK, McNeish B, Silvera VM, Proctor MR, Smith ER.
J Neurosurg Pediatr. 2011 Oct;8(4):384-9.
Tethered cord syndrome.
Agarwalla PK, Dunn IF, Scott RM, Smith ER.
Neurosurg Clin N Am. 2007 Jul;18(3):531-47
Pediatric tethered cord syndrome: response of scoliosis to untethering procedures. Clinical article.
McGirt MJ, Mehta V, Garces-Ambrossi G, Gottfried O, Solakoglu C, Gokaslan ZL, Samdani A, Jallo GI.
J Neurosurg Pediatr. 2009 Sep;4(3):270-4
Outcome, reoperation, and complications in 99 consecutive children operated for tight or fatty filum.
Ostling LR, Bierbrauer KS, Kuntz C 4th.
World Neurosurg. 2012 Jan;77(1):187-91.
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