Management and diagnosis of tethered cord syndrome with filum terminale lipoma

Abstract

Objective To investigate the clinical characteristics,diagnosis and management of tethered cord syndrome（TCS）with filum terminale lipomain children. Methods The clinical data of 61 children（7 months - 14 years old）with filum terminale lipoma were analyzed retrospectively. The auxil-iary examinations including radiography examination,electromyogram examination and urodynamictest. Every child was surgically treated by transecting the filumterminalelipoma and laminoplasty MRI and uro-dynamic index were reviewed after operation,and the spinal cord tethering condition by MRI scaning and the parameters of urodynamic study before operation and after operation were compared. Results Before operation,MRI showed fat signal in the filum,and the conusmedullaris was found at the low level（below the body of L2）on MRI in 52 cases of TCS,conusmedullaris was found at the normal level（above the body of L2）in 9 cases. The position of conusmedullaris showed no significant change,but the filumtemi-nale tense was released after surgery on MRI. The urodynamics test showed overactive type of neurogenic bladder in 37 cases. Detrusorcontractile function partly damaged with more residual urine volume in 5 ca-ses and detrusor debilitation in 19 cases. Forty-nine children had good effects after operation. Twelve children had no evident change in urodynamics. Conclusions TCS children with filum terminale lipoma has insidious onset and the diagnosis should be based on clinical characteristics,physical and radiological examinations. MRI and urodynamics test,the MRI and urodynamics are the key indexes. Key words: Tethered cord syndrome; Filum; Lipoma; Urodynamics; Surgery