Minimally Invasive Surgical Approach to Filum Sectioning: Technical Note.

Abstract

Filum terminale lipoma (FTL) is known to cause various spinal symptoms collectively referred to as tethered cord syndrome (TCS). With the increasing use of magnetic resonance imaging, there has been an increase in the identification of FTLs. The treatment for FTL is surgical untethering by sectioning the filum terminale, which can prevent symptom progression and often results in improvement of symptoms. We recently introduced a new surgical strategy for filum terminale sectioning named interlaminar approach (ILA). In this surgical video, we present a minimally invasive technique of ILA. The surgical approach and postoperative result are outlined. A minimal 2 cm length of midline skin incision was performed at the L5 vertebral level. After skin incision, dissection was extended to expose the ligamentum flavum. The ligamentum flavum was then incised and retracted medially to expose the dural sac. After dural incision, the filum terminale was identified and pulled out from the dural sac and then sectioned. The maximum diameter of the filum terminale was 3 mm in our series. The surgical time for children was about 1 h. Adult patients need a deeper surgical field, so the operation takes more time. Until now, 46 patients (11 mo to 27 yr) have undergone ILA and been followed for more than 5 yr. Surgical complication was seen in only one patient who developed a subcutaneous fluid collection. All patients remained stable or showed improvement in preoperative symptoms. This technique provides the advantage of reduced soft tissue injury and minimal intradural procedures. Thin FTL showing TCS are candidates for ILA. This article complies with the guideline for patient information confidentiality and privacy protection. All the patients in this study provided written, informed consent for the procedure. Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opx127 {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Minimally Invasive Surgical Approach to Filum Sectioning: Technical Note","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_kcc30hx5"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.