Fatty Filum Terminale Tethered Cord Release by Dr. Robin Bowman
With Lurie Children's Hospital
Chapter 1 of 7 · Fundamentals
Tethered cord definition
Introduction and Definition of Tethered Cord Syndrome
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What the experts said
A tethered spinal cord is a neurologic condition that results in the spinal cord becoming abnormally fixed or attached in place, which may stretch or pull on the spinal cord.
A tethered spinal cord is diagnosed by a medical imaging study of the spinal cord, usually an MRI.
Not all patients with tethered spinal cord will develop problems related to this finding.
When surgery called a tethered cord release is recommended, the goal is to prevent further neurological damage.
The higher parts of the spinal cord control the arms, chest, and abdomen, while the lower parts of the spinal cord controls the legs, bowel, and bladder function.
Tethering most commonly occurs at the bottom of the spinal cord.
Signs of tethering may be weakness or sensory changes in the legs or feet, and or changes in the bowel or bladder function.
Most of the time, we do not know why a tethered cord forms during fetal life or why some patients may eventually develop neurologic symptoms related to tethering.
The filum is a string at the bottom of the spinal cord that carries no nervous function.
When the normal filum is infiltrated with fat, it may put an abnormal tension or pull on the bottom of the spinal cord, eventually causing neurological symptoms.
The goal of tethered cord surgery is to release the spinal cord from the abnormal inelastic tethering lesion or string while preserving all functional nervous tissue.
A 2 cm incision is created at the lumbosacral junction, which is usually at the dip in our lower back region.
An operative microscope is utilized to aid the surgeon in finding an optimum visual field by magnifying the intradural space while they work.
For all patients, their leg and bottom nerves and muscles are monitored throughout the procedure by electromyography or EMG.
A monopolar probe is used to stimulate both the filum and the adjacent nerve roots at an intensity of 0.2 milliamps.
No neuromuscular activity is noted in the lower extremities or anal sphincter when the filum is stimulated.
The dura is closed in water tight fashion with seven zero sutures.