What Is the Filum Terminale?
The spinal cord is located in the spinal canal. In the process of human growth and development, the spinal canal grows faster than the spinal cord. Therefore, the lower end of the spinal cord gradually increases relative to the lower end of the spinal canal. Departments, such as recessive spina bifida, meningocele, spinal meningocele, tension in the end of the spinal cord, lumbosacral spinal lipomas, congenital cysts, and latent hair sinus. In addition to the various congenital factors mentioned above, postoperative adhesions of the lumbosacral spinal meningocele can also cause re-tethering of the spinal cord. It is generally believed that spinal cord tethering causes blood circulation disorders at the end of the spinal cord, resulting in corresponding neurological symptoms. [1]
- Western Medicine Name
- Tethered spinal cord
- Affiliated Department
- Surgery-Neurosurgery
- Disease site
- spinal cord
- Contagious
- Non-contagious
| Sun Liyong | (Resident) | Department of Neurosurgery, Xuanwu Hospital, Capital Medical University |
| Wu Hao | (Deputy Chief Physician) | Department of Neurosurgery, Xuanwu Hospital, Capital Medical University |
| Du Jianxin | (Chief physician) | Department of Neurosurgery, Xuanwu Hospital, Capital Medical University |
- Spinal cord tethering is a series of clinical syndromes caused by a variety of congenital abnormalities in the spinal cord. The spinal cord tether is the lower end (cone) of the spinal cord, which is subject to the end of the spinal canal for various reasons, making it lower than normal. Spinal cord tethering can be caused by tension in the terminal cord of the spinal cord, adipose spinal meningocele, recessive spina bifida, spinal fissure deformity, fur sinus and dermoid cysts, and even bladder bulge.
Causes of tethered spinal cord disease
- The spinal cord is located in the spinal canal. In the process of human growth and development, the spinal canal grows faster than the spinal cord. Therefore, the lower end of the spinal cord gradually increases relative to the lower end of the spinal canal. Departments, such as recessive spina bifida, meningocele, spinal meningocele, tension in the end of the spinal cord, lumbosacral spinal lipomas, congenital cysts and latent hair sinus. In addition to the various congenital factors mentioned above, postoperative adhesions of the lumbosacral spinal meningocele can also cause re-tethering of the spinal cord. It is generally believed that spinal cord tethering causes blood circulation disorders at the end of the spinal cord, resulting in corresponding neurological symptoms. [1]
Clinical manifestations of tethered spinal cord
Spinal cord tethering lumbosacral skin changes
- The lumbosacral skin bulges or depressions may be accompanied by secretions or infections; hairy; recessive spina bifida, fur sinus, meningocele, subcutaneous lipomas, etc.
Spinal cord kyphosis or scoliosis deformity
- Forked vertebral body, hemivertebral body and vertebral body fusion.
Dyskinesia of spinal cord tethered lower limb
- It is manifested as abnormal walking, weak lower limbs, and ankle deformation (valves in the hoof).
Spinal cord tethering
- It manifests as paresthesia and pain in the lower limbs, perineum and lower back.
Spinal cord tethering dysfunction
- Common manifestations are urinary retention, difficulty urinating, urinary incontinence, frequent urination, less frequent than usual, etc .; a small number of patients have constipation, constipation, or incontinence.
- Schematic diagram of spinal cord tethering, the left is the normal end of the spinal cord, and the right is the end of the tethered spinal cord that has exceeded the level of the lumbar 2 vertebra
Spinal cord tethering diagnosis and examination
- Diagnostic criteria: The position of the end of the spinal cord (cone) is lower than the level of the waist 2 and the thickness of the terminal filaments is thick (normal diameter <1mm,> 2mm is pathological.) Magnetic resonance (MRI) is the main method for diagnosing spinal cord tethering. With or without spinal cord tethering, you can also learn about other pathological changes that coexist, such as lipomas and longitudinal spina bifida. X-ray film and CT can determine the presence or absence of spina bifida. Combined with urinary and fecal function, urinary system B ultrasound and urodynamic tests were performed to evaluate the degree of urinary system involvement and the impairment of spinal cord nerve function. [2]
Differential diagnosis of tethered spinal cord
- It should be distinguished from congenital spinal cord status (the latter usually has a normal terminal wire diameter).
Treatment of tethered spinal cord disease
- Surgical treatment is preferred, and the purpose of the operation is to loosen the tethered spinal cord.
- If only the terminal wire thickens and becomes shorter, only segmental lumbosacral laminectomy is required, and it is cut off after the identification of the terminal wire;
- If there is a lipoma, if it is easy to separate from the nerve tissue, it can be removed with the terminal filament.
- When performing surgery on patients, they should implement the minimally invasive concept, insist on microsurgery, and cooperate with neuroelectrophysiology monitoring if necessary, in order to completely loosen the tether as far as possible, avoid nerve damage, reduce re-adhesion and tether, and prevent Postoperative wound complications. Follow-up patients were followed up, and prevention and treatment of urinary system dysfunction, rehabilitation of lower limb movement and sensation, and correction of lower limb deformity were given as much guidance as possible. We believe that simply focusing on tethering surgery and ignoring the correct guidance for the continued diagnosis and treatment of these dysfunctions is not good for patients. The common pathological form of recessive spina bifida of lumbosacral region is also the main physiological mechanism of nerve damage caused by spina bifida. [3]