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.
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.