P filum terminale thickness also showed significance in a multivariable analysis with sex and age odds ratio per 0. Although a tight and fibrous filum terminale is present at birth, late onset of symptoms can be explained by the cumulative effect of hypoxia on the conus medullaris, which is. In 1976, hoffman and colleagues coined the term tethered spinal cord to describe the symptoms of their patients with an elongated spinal cord and a thick filum terminale. We also performed research of the latest literature.
Sectioning the filum terminale does not usually involve maneuvers that contribute to retethering of the spinal cord. Incidental isolated fibrolipoma of filum terminale in adult. Various forms include tight filum terminale, lipomeningomyelocele, split cord malformations diastematomyelia, dermal sinus tracts, and dermoids. Thickenedtight filum terminale a delicate filament near the tailbone a history of spine trauma a history of spine surgery symptoms in children. Filum terminale paraganglioma with associated cyst. Soda pdf is the solution for users looking to merge multiple files into a single pdf document. The entity of an occult tight filum terminale syndrome, characterized by clinical findings consistent with a tethered cord syndrome, but with the conus ending in a normal position, has also been recognized recently. Mri of conus medullaris, cauda equina, and filum terminale. The filum disease is an apparently hereditary condition, affecting one in every five individuals. Sleep en drop je pdf of meerdere bestanden naar het bovenstaande vak.
Nevertheless, it is a welldocumented entity, with more than 200 reported cases in the literature. Cystometrography is useful for detecting the lesion and confirming the diagnosis of. During subsequent growth, traction on the spinal cord causes stretching and deformity of the cord. While a number of chiari patients have been found to also have tcs, his idea has not been widely accepted. However, the coincidence of tethered cord syndrome, lipoma, and sdavf on the sacral level is exceptionally rare. Prompt surgical treatment is often necessary to avoid permanent sequelae.
Spinal metastasis presenting as adult tethered cord syndrome. An unusual presentation of adult tethered cord syndrome. Select or drag your files, then click the merge button to download your document into one pdf file. We report a 63yearold man with suddenonset severe right chest and upper back pain, followed by. Medical data of 174 children 20082014 who underwent section of lft were prospectively recorded for. Filum terminale syndrome tethered spinal cord syndrome tight filum terminale a group of neurological disorders with malformations of spinal cord, all of which involves pulling of spinal cord at the base of spinal canal tethered cord. The tight filum terminale syndrome is characterized by a varying array of neurological, urological, andor orthopedic signs and symptoms. Deze gratis online tool maakt het mogelijk om meerdere pdf bestanden of afbeeldingen te combineren in een pdf document.
A family is described in which all 3 siblings manifested the syndrome of tight filum terminale in association with spina bifida occulta of the first sacral segment. Pdf samenvoegen gratis pdfbestanden combineren online. Pain, dysesthesias, neurogenic bladder and spasticity are the common clinical presentations of tethered cord and tight filum terminale. Tight filum terminale syndrome is a complex of neurologic and orthopedic deformities associated with a short, thick filum terminale and low lying conus medullaris with variable clinical manifestations. Historical aspects tulpuis in 1641 was the first to use the term spina bifida. Filum terminale section for moderate mechanical mefibro. The filum terminale was thicker in the lipoma group than the normal group 1. The treatment of a tethered spinal cord caused by a fibrolipomatous filum terminale is a straightforward procedure that achieves good results and minimal morbidity 7.
It gives longitudinal support to the spinal cord and consists of two parts. In radiopedia, the filum terminale is a filament of connective tissue that extends inferiorly from the apex of the conus medullaris. A lipoma or fibrolipoma of the filum terminale is a somewhat uncommon 46% and usually incidental, asymptomatic finding on mris of the lumbar spine. Spinal dural arteriovenous fistula sdavf is the most common vascular malformation of the spine in adults. Spinal cord traction caused by a tight filum terminale may be considered a pathogenic mechanism involved in the development. Subtle imaging findings in a case of tight filum terminale syndrome p i c t o r i a l m e d i c i n e case summary a newborn female infant was found to have a sacral dimple, and left leg hyporeflexia associated with left clubfoot. Tethered cord syndrome tcs refers to a group of neurological disorders that relate to malformations of the spinal cord. Lesion on the lower back fatty tumor or deep dimple on the lower back. Filum terminale fibrolipoma benign, congenital, asymptomatic fat within otherwise normalappearing filum terminale incidental finding found in 46% of autopsy patients no significant epidemiological differences key is to assess if conus is normal in position. Commonly, it is referred to as the tethered spinal cord, a clinical syndrome, recognized by specific imaging abnormalities low conus, thickened filum, spina bifida and coupled with symptoms produced through pathological traction of the lower cord. Regardless of the epidemiology, ces is a spinal emergency necessitating quick and effective care to mitigate permanent neurological sequelae. Gross anatomy the filum terminale is continuous with the pia mater and is described as having two sections. In 1916, spiller 15, a neurologist, described two adolescent patients who presented with symptoms of tethered cord syndrome that developed subsequent to strenuous activity. Annually, cauda equina syndrome ces is believed to newly affect between 1 person per 33,000 100,000.
It is only recently that the true anatomy and pathological involvement of the filum terminale in the tethered cord syndrome have been elucidated. Paraganglioma of the filum terminale pft is a rare tumor and accounts for only 3% to 4% of all tumors arising in the cauda equina region. The first was a 33 yearold female who underwent surgical cord detethering. Yong rl, habrockbach t, vaughan m, kestle jr, steinbok p. Preoperative predictors for improvement after surgical. Shortness of filum terminale represents an anatomical.
Awareness of this rare sequela is necessary for appropriate longterm management of tsc caused by a fatty filum terminale. The filum terminale has often been overlooked in the literature due to its historical lack of research on its true morphology. Garceau in 1953 coined the term filum terminale syndrome after observing 3 patients with progressive spinal deformity and neurological symptoms. The filum terminale terminal thread is a delicate strand of fibrous tissue, about 20 cm in length, proceeding downward from the apex of the conus medullaris.
Measurements were performed on axial images at the level of the l5s1 interspace fig. The former is nearly entirely made of pia mater, the innermost meningeal layer, and extends from the conus medullaris of the spinal cord to the culdesac of the most external meningeal layers, i. Patient selection seems to play a major role in the achievement of successful surgical outcomes in this. Tcs due to tight filum terminale is usually diagnosed in childhood and its onset in adult life is uncommon 14,27,28. A babygram showed no obvious abnormality of the spinal column. The orthopaedic surgeon frequently is the first to observe the patient presenting the symptoms, and, therefore, may direct the patient properly. How to combine files into a pdf adobe acrobat dczelfstudies. A case report was published with documented, via mri, an acquired chiari malformation due to a thickened filum.
The symptoms listed below are some of the ways in which tethered spinal cord syndrome may be exhibited in children. How to merge pdfs and combine pdf files adobe acrobat dc. Differentiation of the filum terminale from the nerve roots. Retethering of the spinal cord is a rare condition occurring after the sectioning of a fatty filum terminale. This free online tool allows to combine multiple pdf or image files into a single pdf document. All forms involve the pulling of the spinal cord at the base of the spinal canal, literally a tethered cord. Choose from a variety of file types multiple pdf files, microsoft word documents, microsoft excel spreadsheets, microsoft powerpoint. Merge pdf online combine pdf files for free foxit software. T2weighted mri hyperintense though not nearly as obvious clinical significance. Pdf tethered cord syndrome associated with a thickened.
Chiari malformations are a group of defects associated with congenital caudal displacement of the cerebellum and brainstem initial descriptions were based on autopsy observations. Spinal lipoma of the filum terminale lft is a congenital lumbosacral anomaly that can cause tethered cord syndrome. Pdfbestanden combineren door het uploaden van hen hieronder. The cauda equina is a set of 10 paired dorsal and ventral nerve roots 20 nerve roots in. Duration of horizontal decubitus after section of a tight. P syndrome tcs represents a spectrum of congenital anomalies characterized by an abnormal caudal position and traction of the conus medullaris. Following a detailed diagnostic assessment and the latter application of the minimally invasive surgical sectioning of the filum terminale, the cause for the disease is eliminated, which on top of eliminating the diseases cause and halting its progression does not have any harmful collateral. Types ii and iii are thought to be related to each other while type i represents a distinct entity 1 chiari i malformation.
Combine multiple pdf files into one pdf, try foxit pdf merge tool online free and easy to use. Differentiating tethered cord syndrome, neurocranio. Tight filum terminale syndrome neurosurgery oxford. Cauda equina, filum terminale, spinal nerve roots, conus medullaris cauda equina is the latin name for horses tail because the cauda equina resembles a horse tail. Fibrolipoma of the filum terminale the pain source.
Adult tethered cord syndrome atcs is a rare entity that usually presents with multiple neurological symptoms, including lower extremity pain, backache, lower extremity muscle weakness, and bowelbladder disturbances. The upper part, or filum terminale internum, is about 15 cm long and reaches as far as the lower border of the. Filum terminale normal filum thickness is stated to be 2 mm or less 6, 7. Symptomatic retethering of the spinal cord after section of a tight filum terminale.
Tethered spinal cord syndrome causes, diagnosis and. Subtle imaging findings in a case of tight filum terminale. Retethering of sectioned fibrolipomatous filum terminales. Purposes of this study are to clarify preoperative characteristics of lft, to elucidate surgical effects, and to discuss the rationale of prophylactic surgery for lft. Pdf samenvoegen online pdf bestanden combineren of. Maakt het mogelijk om pdfbestanden samen te voegen met een simpele drag anddrop interface. Wehby mc, ohollaren ps, abtin k, hume jl, richards bj.
Several recent studies have reported a benefit to filum sectioning in occult tight filum terminale syndrome 3,4,5,6. Meerdere pdf documenten samenvoegen tot een pdf document. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks. Three types were described, with others added later.
Two boys, 14 and 18 years of age, presented with leg weakness and. Split cord malformation scm associated with tight filum. It is the simplest form of conditions causing tethered cord syndrome tcs and the filum terminale can be thickened, normally with lipomatous tissue1,3. A tight filum terminale may cause the cordtraction symptoms known as the arnoldchiari syndrome. The indications for sectioning the filum terminale in this situation are not well characterized and remain controversial. In healthy newborns, the tip of the conus medullaris is located between l1 and l2. Easily combine multiple files into one pdf document. Retethering of transected fatty filum terminales in. Hence, in patients affected by scms, abnormality of the filum terminale cannot be indicative of a tethered cord due to tight filum terminale.
A mobile ependymoma of the filum terminale published on feb 1963 by journal of neurosurgery publishing group. Split pdf files into individual pages, delete or rotate pages, easily merge pdf files together or edit and modify pdf files. If the filum terminale is tight or has lost its elastic properties, the traction effect on the conus medullaris may lead to the development of tethered cord syndrome. We describe two patients, probably the fifth and sixth ever reported.
Pdf merge combine pdf files free tool to merge pdf online. Section of the filum terminale surgery for tethered spinal. Frontiers coincidence of tethered cord, filum terminale. The filum terminale is a cordlike echogenic structure fig 5, which is surrounded by the echogenic roots of the cauda equina. The fatty filum involves fatty infiltration of the whole length or of part of the filum terminale. Classification congenital spinal dysra phisms can be classified on the basis of the presence or absence of a softtissue mass and skin covering 2.