The tethered cord syndrome and occult tethered cord syndrome can be present in patients not only in "pure" form, but also in association with other syndromes or pathological conditions. I am referring to Ehlers-Danlos syndrome, craniocervical instability, CHIARI MALFORMATION TYPE I (CM1), and LOW-LYING CEREBELLAR TONSILS (LLCT).
For these last two conditions, I suggest watching Dr. Bolognese's video, in which he discusses in detail his scientific study conducted on over 3,000 patients (ASSOCIATION OF CHIARI MALFORMATION TYPE I AND TETHERED CORD SYNDROME: PRELIMINARY RESULTS OF THE SECTION OF THE FILUM TERMINALE. Authors: Milhorat TH, Bolognese PA et al. Surg Neurol 72:20-35, 2009).
In this scientific study, an association between tethered cord syndrome and occult tethered cord syndrome is reported in 14% of patients with Chiari malformation type I and in 63% with low-lying cerebellar tonsils (LLCT).
In his video, Dr. Bolognese describes the aforementioned scientific article in detail; in particular, I emphasize that OCCULT TETHERED CORD SYNDROME WAS 93% of the total cases generally defined as tethered cord syndromes, as can be seen in the photo below taken from the video.
In my opinion, this is the best scientific article on this subject.
The video goes into the details of the scientific article.
© Copyright 2020 Vanni VERONESI. All rights reserved.
Privacy Notice (ITALIANO) / Privacy Policy (ENGLISH)Cookie Notice (ITALIANO) / Cookies information (ENGLISH)
Tethered cord syndrome and occult tethered cord syndrome
The symptoms of patients with TETHERED CORD SYNDROME are the same as those of patients with OCCULT TETHERED CORD SYNDROME.
Symptoms involve the lower limbs, with pain, tingling, and easy fatigue; low back pain; and difficulty controlling bowel movements, often urinary tract and sometimes bowel movements (the various symptoms may not all be present simultaneously).
Patients are mostly children, adolescents, and young adults.
Diagnosing these TETHERED CORD SYNDROME and OCCULT TETHERED CORD SYNDROME can be challenging (further information is available on the homepage).
The goal of the extradural filum terminale section is to identify and treat the classic symptoms attributable to occult tethered cord syndrome and tethered cord syndrome.
The clinical diagnosis of tethered cord syndrome, or occult tethered cord, is based on the clinical history, symptoms, and physical examination, supported by specific postural tests.
The instrumental support, which alone does not allow diagnosis, is lumbar MRI.
In tethered cord syndrome, standard lumbar MRI shows the conus medullaris more caudal than the usual level of the L1-L2 lumbar vertebrae.
If the conus medullaris terminates in a normal location, we suggest a prone lumbar MRI to provide instrumental support for the clinical diagnosis of occult tethered cord syndrome.
Only two scientific articles have evaluated prone lumbar MRI in occult tethered cord syndrome in the medical literature: one by Japanese colleagues from the University of Hiroshima and one by myself:
- Use of prone position magnetic resonance imaging for detecting the terminal filum in patients with occult tethered cord syndrome. Authors: Nakanishi K. et al. J Neurosurg Spine 18:76–84, 2013;
- Prone position magnetic resonance imaging and transhiatal approach to filum terminale externum sectioning in adolescents with occult tethered cord syndrome: report of four cases. Authors: Veronesi V. et al. Pediatric Neurosurgery; 2020;55(6):432-438.
However, prone lumbar MRI alone does not allow for a diagnosis of occult tethered cord syndrome, but it does support the clinical diagnosis.
The clinical diagnosis of tethered cord syndrome, or occult tethered cord, is based on the clinical history, symptoms, and physical examination findings, supported by specific postural tests.
The problem is that prone lumbar MRI is not routinely performed in hospitals.
In Italy, only a few medical centers correctly perform prone lumbar MRIs.
I have published the MINIMALLY INVASIVE TECHNIQUE UNDER LOCAL ANESTHESIA for EXTRADURAL FILUM TERMINALE SECTION for the treatment of tethered cord syndrome or occult tethered cord syndrome, which I have been performing since 2010, in the international scientific journal “Operative Neurosurgery”:
- TRANSHIATAL APPROACH TO FILUM TERMINALE EXTERNUM SECTIONING IN AN ADULT PATIENT WITH TETHERED CORD SYNDROME: CASE REPORT. Authors: Veronesi V. et al. Operative Neurosurgery, 2018 Jul 1;15(1): E1-E4.
In my experience, patients operated on using the MINIMALLY INVASIVE SURGICAL TECHNIQUE UNDER LOCAL ANESTHESIA for EXTRADURAL FILUM TERMINALE SECTIONING for tethered cord syndrome or occult tethered cord syndrome can experience improvements even in symptoms not classically attributable to these syndromes, as can be heard in the video testimonials and read in the written testimonials available on the Qsalute website.
Tethered cord syndrome and occult tethered cord syndrome may be present in patients not only in their "pure" form, but also in association with other syndromes or pathological conditions:
- Chiari malformation type I (CM1);
- Low-Lying cerebellar tonsils (LLCT);
- Ehlers-Danlos syndrome (EDS);
- Craniocervical instability (CCI).
TETHERED CORD SYNDROME AND OCCULT TETHERED CORD SYNDROME IN PATIENTS WITH CHIARI MALFORMATION TYPE 1 (CM1)
OR MILD DESCENT OF THE CEREBELLAR TONSILS (LLCT)
In my opinion, this is the best scientific article on this subject
There are many reasons why I consider this scientific article, published in 2009, a milestone on this topic: the authors' authority, the large case series of over 3,000 patients, the fact that they also evaluated mild cerebellar tonsil descent (LLT) and not just sufficient cerebellar tonsil descent to qualify as Chiari malformation type I (CM1), and the correlation between varying degrees of cerebellar tonsil descent and tethered cord syndrome and occult tethered cord syndrome.
This scientific study reports an association between LLT and occult tethered cord syndrome in 14% of patients with Chiari malformation type I and in 63% with LLCT.
In his video (see link below), Dr. Bolognese describes the aforementioned scientific article in detail; In particular, I emphasize that OCCULT TEETHED CORD SYNDROME accounted for 93% of the total cases generically defined as tethered cord syndromes, as can be seen in the photo below from the video.
I would like to emphasize that the surgical treatment of tethered cord syndrome and occult tethered cord syndrome was performed by Dr. Bolognese using the CLASSIC SURGICAL TECHNIQUE, under general anesthesia, by sectioning the intradural filum terminale.
My MINIMALLY INVASIVE surgery under local anesthesia for the extradural section of the filum terminale, which I will discuss in more detail here and elsewhere on the website, was published later in 2018, although I have been performing it since 2010.
The video goes into the details of the scientific article of Dr. Bolognese.
Below is an explanatory slide that appears at 8 and 56 seconds of the video.
Abbreviation:
TC = Tethered cord
CMI = Chiari malformation Type I
LLCT = Low Lying Cerebellar Tonsils
SFT = Section Filum Terminale
