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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
The reasons why I consider this scientific article published in 2009 a milestone on this subject are many: the authority of the Authors, the large case series of over 3000 patients, the fact that they also evaluated the mild descent of the cerebellar tonsils (Low-Lying Cerebellar Tonsils) and not only the descent of the cerebellar tonsils sufficient to configure Chiari type I malformation (CM1), and the correlation of the various descents of the cerebellar tonsils with tethered cord syndrome and occult tethered cord syndrome.
I would like to point out that the surgical treatment of tethered cord syndrome and occult tethered cord syndrome was performed under GENERAL ANESTHESIA with section of the INTRADURAL FILUM TERMINALE.
My minimally invasive surgical procedure under LOCAL ANESTHESIA for the EXTRADURAL section of the FILUM TERMINALE, which I will discuss further here and on other pages of 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
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.
Tethered cord syndrome and occult tethered cord syndrome
In my experience, patients operated on with the MINI-INVASIVE SURGICAL TECHNIQUE UNDER LOCAL ANESTHESIA for the SECTION of the EXTRADURAL FILUM TERMINALE may experience improvements even in those symptoms not classically attributed to tethered cord syndrome or occult tethered cord syndrome, as can be seen in the video testimonials and read in the written testimonials found on my website.
However, the goal of the section of the extradural filum terminale 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 syndrome is based on clinical history, symptoms, and medical examination.
Instrumental support, which alone does not allow diagnosis, is lumbar magnetic resonance imaging.
In tethered cord syndrome, standard lumbar magnetic resonance imaging finds the conus medullaris more caudal than the usual level of the L1-L2 lumbar vertebrae.
If the conus medullaris ends in a normal position, we suggest a lumbar MRI in the prone position to provide instrumental support for the clinical diagnosis of occult tethered cord syndrome.
Only two scientific articles have evaluated lumbar MRI in the prone position in occult tethered cord syndrome in the medical-scientific literature: one by Japanese colleagues from Hiroshima University 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 diagnosis, but supports the clinical diagnosis of occult tethered cord syndrome.
The clinical diagnosis is made based on history, symptoms, and the outcome of the medical examination.
The problem is that prone lumbar MRI is not routinely performed in hospitals.
In Italy, only a few medical centers collaborate with me and properly perform lumbar MRIs in the prone position.
I have published the minimally invasive surgical procedure of extradural filum terminale sectioning under local anesthesia for the treatment of occult tethered cord syndrome in the international scientific journal "Operative Neurosurgery";
- TRANSHIATAL APPROACH TO FILUM TERMINALE EXTERNUM SECTIONING IN ADULT PATIENT WITH TETHERED CORD SYNDROME: CASE REPORT.
Authors: Veronesi V. et al. Operative Neurosurgery, 2018 Jul 1;15(1): E1-E4.
This minimally invasive surgical procedure under anesthesia can be used to treat occult tethered cord syndrome but also tethered cord syndrome.