Surgical outcomes by sectioning a filum terminale in patients with terminal syringomyelia
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ORIGINAL ARTICLE
Surgical outcomes by sectioning a filum terminale in patients with terminal syringomyelia Eitaro Ishisaka 1 & Kenichi Usami 1 & Hideki Ogiwara 1 Received: 21 March 2020 / Accepted: 7 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Although terminal syringomyelia suggests a tethered spinal cord, a consensus has still not been established for surgical indications, when there are no associated abnormalities or only minor associated abnormalities. We analyzed surgical outcomes of sectioning a filum terminale in patients with terminal syringomyelia to elucidate the significance of untethering surgery. Methods Fifty-seven pediatric patients with terminal syringomyelia who underwent untethering via sectioning the filum terminale between 2007 and 2018 were retrospectively analyzed. Postoperative outcomes of symptoms and MRI findings were evaluated. Results Of 57 patients, 40 had other associated abnormalities (25 with filar lipoma and 29 with low conus medullaris) that could be responsible for tethered cord. Nineteen patients had symptoms. The mean age at the time of surgery was 18 months (3– 96 months). The mean follow-up period was 3.3 years (1–9 years). Preoperative symptoms improved in 9 patients (47%) after surgery. At 1 year after the surgery, the size of syringomyelia decreased in 19 (33%), increased in 4 (8%), and did not change in 34 (69%) patients. Of 28 patients who were followed up for more than 3 years, the size decreased in 17 (61%), increased in 1 (4%), and did not change in 10 (35%). Conclusion When untethering was performed by sectioning a filum terminale, the size of terminal syringomyelia decreased in more than half of patients in the long term. Sectioning the filum terminale demonstrated the possibility of radiological and clinical improvement in patients with terminal syringomyelia. Keywords Terminal syringomyelia . Untethering . Filum terminale
Introduction Syringomyelia or spinal cord syrinx may be caused by tumors, trauma, inflammation, or congenital anomalies. Terminal syringomyelia in the lower part of the spinal cord, especially found in childhood, can be associated with tethered cord syndrome. On the other hand, idiopathic syringomyelia also occurs with no particular causes, and the natural history of it is unclear. Surgical untethering is commonly performed in patients with clear radiologic abnormalities, such as spinal meningoceles or spinal lipomas. However, in patients with minor abnormalities such as thickened filum terminale, filar lipoma, and low conus medullaris on MRIs, or in patients
without associated abnormalities, a consensus has still not been established regarding surgical indication. The outcome of syringomyelia and its symptoms after untethering has also rarely been reported. Therefore, it is unclear whether conservative management or to perform untethering surgery at an early stage is better, when terminal syringomyelia is diagnosed in children. Herein, we evaluated long-term outcomes in patients with terminal syr
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