Document Detail


Minimal tethered cord syndrome associated with thickening of the terminal filum.
MedLine Citation:
PMID:  16970235     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The authors investigated the occurrence of anatomical abnormalities of the terminal filum in children undergoing surgical filum lysis for minimal tethered cord syndrome (TCS). METHODS: Five consecutive children (age range 6-12 years) with medically refractory voiding dysfunction but no magnetic resonance (MR) imaging-documented lumbosacral abnormality on 1.5-tesla sequences underwent preoperative urodynamic studies consisting of calibrated uroflowmetry, cystometrography, and voiding cystourethrography. Urodynamic bladder function was abnormal in each case. A sixth child (5 years of age) who had progressive lower-extremity weakness, gait abnormality, and voiding dysfunction, but in whom there was no MR imaging-documented lumbosacral abnormality, was also included. These six children experienced improved bladder function after terminal filum lysis. Histologically, the terminal filum in these patients was fattier, thicker, and more densely fibrous than that in three reference patients undergoing incidental terminal filum lysis during selective dorsal rhizotomy or resection of a lumbar dermal sinus tract. All four patients with voiding dysfunction who underwent postoperative urodynamic testing experienced corresponding improvement in bladder function. CONCLUSIONS: Significant improvement of voiding dysfunction after surgical lysis of the terminal filum in children with MR imaging-documented normal lumbosacral spines was observed. In such children, in whom neurogenic dysfunction is identified by urodynamic testing, structural abnormalities of the terminal filum may exist. A prospective randomized controlled study of children undergoing surgical terminal filum lysis in cases of minimal TCS should be undertaken.
Authors:
Nathan R Selden; Randal R Nixon; Steven R Skoog; David B Lashley
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  105     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-14     Completed Date:  2006-10-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  214-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Pediatric Neurosurgery, Department of Neurological Surgery, Oregon Health and Science University, Portland 97239, USA. seldenn@ohsu.edu
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MeSH Terms
Descriptor/Qualifier:
Case-Control Studies
Cauda Equina / pathology*,  surgery*
Child
Child, Preschool
Female
Fibrosis / complications,  pathology,  surgery
Humans
Male
Neural Tube Defects / complications,  pathology*,  surgery*
Treatment Outcome
Urinary Bladder, Neurogenic / etiology,  physiopathology
Urodynamics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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