Symptomatic retethering of the spinal cord after section of a tight filum terminale
| Autor: | Raymund L. Yong, Tracey Habrock-Bach, Mariko Vaughan, John R. W. Kestle, Paul Steinbok |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Cord Adolescent Cauda Equina Neurosurgical Procedures Young Adult Recurrence Risk Factors Medicine Humans Neural Tube Defects Young adult Child Retrospective Studies Aged 80 and over business.industry Infant Retrospective cohort study medicine.disease Spinal cord Surgery medicine.anatomical_structure El Niño Child Preschool Female Neurology (clinical) Filum terminale Arachnoiditis business Complication |
| Zdroj: | Neurosurgery. 68(6) |
| ISSN: | 1524-4040 |
| Popis: | Background Section of a tight filum terminale is a minimally invasive procedure compared with cord untethering procedures used for more complex spinal abnormalities. Anecdotal evidence suggests, however, that the risk of symptomatic retethering resulting from scarring might be higher than previously thought. Objective To determine the frequency of symptomatic retethering after section of a tight filum terminale and to explore possible risk factors. Methods We reviewed databases at 2 pediatric neurosurgery centers for all patients who had surgery for a suspected tight filum terminale between January 1982 and June 2009. Results We identified 152 patients. The median length of follow-up was 78 months. Thirteen patients (8.6%) went on to retether symptomatically at a median time of 23.4 months after the initial procedure. Eight had early retethering (within 2 years) and 5 had late retethering (after 7 years). Compared with late retetherers, early retetherers were older at initial surgery (median, 9.4 vs 0.9 years of age), had a higher level of the conus (median, L1/L2 vs L3/L4), had more arachnoiditis after initial surgery, and required more repeat untethering procedures. Late retetherers were younger at initial surgery than those who did not retether (median, 0.9 vs 4.5 years of age). Conclusion Symptomatic retethering is not uncommon after a simple filum snip, and long-term follow-up is warranted. Two distinct patterns of retethering were observed. Arachnoiditis caused by infection or a cerebrospinal fluid fistula may predispose to early retethering, whereas early surgery for prevention of tethered cord symptoms may predispose to late retethering. |
| Databáze: | OpenAIRE |
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