Filum Terminale section for moderate mechanical ME/Fibro? (Barcelona Institute)

pattismith

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In Radiopedia, The filum terminale is a filament of connective tissue that extends inferiorly from the apex of the conus medullaris.

apex of the conus medullaris.
Gross anatomy
The filum terminale is continuous with the pia mater and is described as having two sections:
  • filum terminale internum: upper three quarters of the filum; covered by the spinal dura and arachnoid meninges
  • filum terminale externum: lower quarter of the filum; fuses with the investing dura mater and continues inferiorly to attach to the dorsal coccyx
Variant anatomy
  • fatty filum terminale: can be considered as a cause of tethered cord 4 or may be considered a rare (<0.5%) anatomical variant in the asymptomatic patient 3
  • ventriculus terminalis
Related pathology

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The Institut Chiari & Siringomielia & Escoliosis of Barcelona does a surgical procedure on the Filum Terminale to stop strain on cord and brainstem, they claim to have good rate of improvement with this?

Please consult the Patient Satisfaction Rate for more than 900 patients that have undergone surgery by the means of our health method Filum System® that includes twelve protocols, of which the fourth is our exclusive surgical Sectioning of the Filum Terminale technique, in the pathologies Arnold Chiari I Syndrome, Syringomyelia, Scoliosis, Basilar Impression, Platybasia, Retroflexed Odontoid, Kinking of the Brainstem and others.
 

pattismith

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it seems another team in italy is doing Filium terminale section


Shortness of filum terminale represents an anatomical specific feature in fibromyalgia: a nuclear magnetic resonance and clinical study
Roberto Mantia,1 Marco Di Gesù,1 Angelo Vetro,1 Fabrizio Mantia,1 Sebastiano Palma,2 and Angelo Iovane3
Roberto Mantia
1 Medical Center Mantia, Palermo, Italy
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Marco Di Gesù
1 Medical Center Mantia, Palermo, Italy
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Angelo Vetro
1 Medical Center Mantia, Palermo, Italy
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Fabrizio Mantia
1 Medical Center Mantia, Palermo, Italy
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Sebastiano Palma
2 Radiology Institute, University of Palermo, Italy
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Angelo Iovane
3 Sport and Exercise Sciences Research Unit, University of Palermo, Italy
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Author information Copyright and License information Disclaimer
1 Medical Center Mantia, Palermo, Italy
2 Radiology Institute, University of Palermo, Italy
3 Sport and Exercise Sciences Research Unit, University of Palermo, Italy
Corresponding author: Marco Di Gesù, Medical Center Mantia, Via Francesco Ferrara, 90141 Palermo, Italy, E-mail: ti.aitnamocidemortnec@usegid.m

Copyright © 2015, CIC Edizioni Internazionali


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Summary
Background:
we aimed to assess whether shortness of filum terminale (FT) can represent a specific feature of fibromyalgia. Therefore we investigated benefits coming from FT section with a mini-invasive technique in patients with fibromyalgia. Filum terminale disease (FD), described firstly in 1996, is consequence of an abnormal traction exerted on spinal cord since FT is shorter than usual. Fibromyalgia syndrome (FS) is featured by chronic widespread musculoskeletal pain associated with stiffness and extra-skeletal symptoms affecting many organs and systems. Filum terminale disease and fibromyalgia syndrome share common clinical features in at least one subset of patients.
Methods:
we evaluated 42 patients firstly diagnosed for FS and then re-evaluated by nuclear magnetic resonance. 38 out of 42 had also FD and 20 of them underwent surgical treatment, i.e., FT section according to Royo-Salvador technique.
Results:
after physical therapy, surgically treated patients showed significant improvement of symptoms in terms of reduction of pain and increment of quality of life, compared to group, which refused surgery and performed physical therapy only.
Conclusion:
we suggest that FT shortness can be considered one of predisposing causes for developing FS and that FD surgical treatment in patients with FS can improve overall treatment outcome.
 

pattismith

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Some teams are able to perform Section of the Filium Terminale by minimal surgery (endoscopy);

Maybe JenB had this kind of procedure?


Minimally invasive endoscopic spinal cord untethering: case report
Albert Edward Telfeian1, Michael Punsoni2, Christoph P. Hofstetter3
1Department of Neurosurgery, 2Department of Pathology, Warren Alpert Medical School of Brown University, Providence, RI, USA; 3Department of Neurosurgery, University of Washington, Seattle, WA, USA
Correspondence to: Albert Edward Telfeian. Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA. Email: atelfeian@lifespan.org.
Abstract: Tethered cord syndrome is a constellation of symptoms and signs that include back and leg pain, bowel and bladder dysfunction, scoliosis and lower extremity weakness and deformity. Tethering may be due to a tight filum terminale or a form of spinal dysraphism. The authors present a case of a 40-year-old man who presented with symptoms of back pain, bilateral lower extremity radicular pain, and bowel and bladder dysfunction. Magnetic resonance imaging showed a sacral lipomyelomeningocele, with fat tracking superiorly to the conus, which was tethered at the L4–L5 level. A minimally-invasive surgical approach with endoscopic visualization and identification of the nerve roots and filum terminale was performed. The patient’s postoperative clinical course was uneventful. This case highlights two important issues. First, minimally invasive spine techniques should be considered in the surgical treatment of tethered cord especially given the theoretical advantages of minimizing pain, spinal fluid leakage, and subsequent scarring. And second, endoscopic techniques are advancing. In the case presented here, endoscopic visualization and operative techniques made identification and transection of the filum terminale possible through a tiny dural opening. The small dural opening could theoretically pose the advantage of decreasing the risk of spinal fluid leakage. Clinicians should be aware that endoscopic visualization and techniques can serve as minimally-invasive adjuncts to enhance the traditional approach to many surgical pathologies.