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”.
• Spinal cord normally hangs freely in the canal & moves up & down with growth, & with bending, stretching etc.
• A tethered spinal cord held taut at the end/ other point in the canal→ force the cord to stretch as the child grow & in adults during normal activity causing progressive spinal cord damage.
• Types- Congenital e.g. tight filum terminale;
  Acquired- after injury.
• Clinical features:  In Children- Low back ache, Foot & spinal deformities, Weakness of lower limbs, Scoliosis, Hairy patches or dimples at lower back.
  →may be undiagnosed until adulthood when delayed presentation of sensory, motor, bowel & bladder symptoms
  →In adults, low back-ache with radiation to thigh, legs & perineum; muscle weakness, sensory deficiency, bladder/bowel incontinence or retention.
  → Neurological symptoms with mixed features of UMN & LMN findings.
• Treatments:–
  a) Early Surgery- recommended in children when symptoms started worsening to prevent further neurological damage

In adults- previously asymptomatic started feeling pain, loer back degeneration, scoliosis, bladder/bowel control  issues & incontinence
surgery done to free the cord to restore some function or decrease symptoms
b) Symptomatic treatment- Analgesics like NSAIDs, Opoids for relief of pain, Physiotherapy e.g. TENS

• Prognosis- Progression with age but after surgery-normal life; neurological impairments- usually irreversible.
• Occult Filum Terminale- Thickening & hardening of filum terminale causing downward pull on spinal cord causing scoliosis  & all the symptoms mentioned above  >treated by surgery.