{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T07:06:29Z","timestamp":1783148789242,"version":"3.54.6"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,4,28]],"date-time":"2022-04-28T00:00:00Z","timestamp":1651104000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,28]],"date-time":"2022-04-28T00:00:00Z","timestamp":1651104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>The purpose of this study was to evaluate outcome following surgical transection of filum terminale (FT) in symptomatic and asymptomatic pediatric patients with radiological findings consistent with tethered cord syndrome (TCS).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients\u2009&lt;\u200917\u00a0years who underwent untethering surgery between 2007 and 2018 were screened for eligibility. Those who had undergone primary transection of the FT, and had preoperative radiological findings of fatty filum, thickened FT, or low-lying conus, below the pedicles of L2, were included. The cohort was divided into symptomatic and asymptomatic depending on clinical presentation. Surgical complications and functional outcome was recorded.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In total, 95 patients were included, of whom 62 were symptomatic. In symptomatic patients, the main indications for radiological evaluation were scoliosis (29%) and motor symptoms (19%). In asymptomatic patients, skin stigmata (76%) were the most common finding. Fatty or thick FT was the most common radiographic finding, seen in 61% of symptomatic and 79% of asymptomatic cases. All patients underwent transection of the FT and were followed for a median of 1.8\u00a0years. A postoperative complication occurred in 12%, all Ibanez type Ib and managed without invasive treatment. For the symptomatic cohort, significant improvement was seen for both urodynamic assessment (48% improved, <jats:italic>p<\/jats:italic>\u2009=\u20090.002) and sensorimotor function (42% improved, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Neurological improvement or halted deterioration was seen in the majority of symptomatic cases. Asymptomatic patients did not experience any severe complications. Filum transection should be offered to symptomatic and asymptomatic patients upon diagnosis of fatty filum, thickened FT, or low-lying conus.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00701-022-05218-6","type":"journal-article","created":{"date-parts":[[2022,4,28]],"date-time":"2022-04-28T13:08:16Z","timestamp":1651151296000},"page":"1473-1480","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Filum terminale transection in pediatric tethered cord syndrome: a single center, population-based, cohort study of 95 cases"],"prefix":"10.1007","volume":"164","author":[{"given":"Erik","family":"Edstr\u00f6m","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Wessl\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Fletcher-Sandersj\u00f6\u00f6","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3776-6136","authenticated-orcid":false,"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrika","family":"Sandvik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,28]]},"reference":[{"issue":"3","key":"5218_CR1","doi-asserted-by":"publisher","first-page":"337","DOI":"10.21037\/jss.2019.09.02","volume":"5","author":"AD Bhimani","year":"2019","unstructured":"Bhimani AD et al (2019) Pediatric tethered cord release: an epidemiological and postoperative complication analysis. J Spine Surg 5(3):337\u2013350","journal-title":"J Spine Surg"},{"issue":"1","key":"5218_CR2","doi-asserted-by":"publisher","first-page":"e3","DOI":"10.3171\/foc.2001.10.1.4","volume":"10","author":"JP Blount","year":"2001","unstructured":"Blount JP, Elton S (2001) Spinal lipomas. Neurosurg Focus 10(1):e3","journal-title":"Neurosurg Focus"},{"issue":"7","key":"5218_CR3","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1097\/00007632-199404000-00018","volume":"19","author":"E Brown","year":"1994","unstructured":"Brown E et al (1994) Prevalence of incidental intraspinal lipoma of the lumbosacral spine as determined by MRI. Spine 19(7):833\u20136","journal-title":"Spine"},{"issue":"2","key":"5218_CR4","doi-asserted-by":"publisher","first-page":"E2","DOI":"10.3171\/FOC-07\/08\/E2","volume":"23","author":"CJ Bui","year":"2007","unstructured":"Bui CJ, Tubbs RS, Oakes WJ (2007) Tethered cord syndrome in children: a review. Neurosurg Focus 23(2):E2","journal-title":"Neurosurg Focus"},{"issue":"17","key":"5218_CR5","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1097\/BRS.0b013e3181b07914","volume":"34","author":"M Cardoso","year":"2009","unstructured":"Cardoso M, Keating RF (2009) Neurosurgical management of spinal dysraphism and neurogenic scoliosis. Spine 34(17):1775\u201382","journal-title":"Spine"},{"issue":"5","key":"5218_CR6","doi-asserted-by":"publisher","first-page":"559","DOI":"10.3171\/2014.2.PEDS13528","volume":"13","author":"MJ Cools","year":"2014","unstructured":"Cools MJ et al (2014) Filum terminale lipomas: imaging prevalence, natural history, and conus position. J Neurosurg Pediatr 13(5):559\u2013567","journal-title":"J Neurosurg Pediatr"},{"issue":"9","key":"5218_CR7","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1007\/s00381-015-2748-9","volume":"31","author":"M Geyik","year":"2015","unstructured":"Geyik M et al (2015) Tethered cord syndrome in children: a single-center experience with 162 patients. Childs Nerv Syst 31(9):1559\u20131563","journal-title":"Childs Nerv Syst"},{"issue":"4","key":"5218_CR8","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1007\/s12098-007-0060-8","volume":"74","author":"MK Kasliwal","year":"2007","unstructured":"Kasliwal MK, Mahapatra AK (2007) Surgery for spinal cord lipomas. Indian J Pediatr 74(4):357\u2013362","journal-title":"Indian J Pediatr"},{"issue":"4","key":"5218_CR9","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1227\/01.NEU.0000114923.76542.81","volume":"54","author":"AV Kulkarni","year":"2004","unstructured":"Kulkarni AV, Pierre-Kahn A, Zerah M (2004) Conservative management of asymptomatic spinal lipomas of the conus. Neurosurgery 54(4):868\u201373; discussion 873-5","journal-title":"Neurosurgery"},{"issue":"5\u20136","key":"5218_CR10","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/j.wneu.2010.11.010","volume":"75","author":"FA Landriel Iba\u00f1ez","year":"2011","unstructured":"Landriel Iba\u00f1ez FA et al (2011) A new classification of complications in neurosurgery. World Neurosurg 75(5\u20136):709\u201315; discussion 604-11","journal-title":"World Neurosurg"},{"issue":"3","key":"5218_CR11","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1159\/000098836","volume":"43","author":"SM Lew","year":"2007","unstructured":"Lew SM, Kothbauer KF (2007) Tethered cord syndrome: an updated review. Pediatr Neurosurg 43(3):236\u2013248","journal-title":"Pediatr Neurosurg"},{"issue":"4","key":"5218_CR12","doi-asserted-by":"publisher","first-page":"e1084","DOI":"10.1542\/peds.2015-0071","volume":"135","author":"CO Maher","year":"2015","unstructured":"Maher CO, Piatt JH Jr (2015) Incidental findings on brain and spine imaging in children. Pediatrics 135(4):e1084\u2013e1096","journal-title":"Pediatrics"},{"issue":"3","key":"5218_CR13","doi-asserted-by":"publisher","first-page":"551","DOI":"10.4184\/asj.2018.12.3.551","volume":"12","author":"T Seki","year":"2018","unstructured":"Seki T et al (2018) Surgical outcomes of pediatric patients with asymptomatic tethered cord syndrome. Asian Spine J 12(3):551\u2013555","journal-title":"Asian Spine J"},{"issue":"3","key":"5218_CR14","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1007\/s003810050482","volume":"16","author":"M Sel\u00e7uki","year":"2000","unstructured":"Sel\u00e7uki M et al (2000) Patients with urinary incontinence often benefit from surgical detethering of tight filum terminale. Childs Nerv Syst 16(3):150\u20134; discussion 155","journal-title":"Childs Nerv Syst"},{"key":"5218_CR15","unstructured":"Singh R, Munakomi S (2022) Embryology, Neural Tube. In: StatPearls. StatPearls PublishingCopyright \u00a9 2022. StatPearls Publishing LLC, Treasure Island"},{"issue":"3","key":"5218_CR16","doi-asserted-by":"publisher","first-page":"245","DOI":"10.3171\/2014.5.PEDS13399","volume":"14","author":"G Talamonti","year":"2014","unstructured":"Talamonti G et al (2014) Asymptomatic lipomas of the medullary conus: surgical treatment versus conservative management. J Neurosurg Pediatr 14(3):245\u2013254","journal-title":"J Neurosurg Pediatr"},{"issue":"3","key":"5218_CR17","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1002\/nau.23382","volume":"37","author":"GF Tuite","year":"2018","unstructured":"Tuite GF et al (2018) Evaluation and management of tethered cord syndrome in occult spinal dysraphism: recommendations from the international children\u2019s continence society. Neurourol Urodyn 37(3):890\u2013903","journal-title":"Neurourol Urodyn"},{"issue":"5","key":"5218_CR18","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1016\/j.jpedsurg.2004.01.023","volume":"39","author":"SE Tuuha","year":"2004","unstructured":"Tuuha SE et al (2004) Is surgery necessary for asymptomatic tethered cord in anorectal malformation patients? J Pediatr Surg 39(5):773\u2013777","journal-title":"J Pediatr Surg"},{"issue":"4","key":"5218_CR19","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1007\/BF00587817","volume":"33","author":"A Uchino","year":"1991","unstructured":"Uchino A, Mori T, Ohno M (1991) Thickened fatty filum terminale: MR imaging. Neuroradiology 33(4):331\u2013333","journal-title":"Neuroradiology"},{"issue":"7","key":"5218_CR20","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1007\/s00381-016-3072-8","volume":"32","author":"K Usami","year":"2016","unstructured":"Usami K et al (2016) Spinal lipoma of the filum terminale: review of 174 consecutive patients. Childs Nerv Syst 32(7):1265\u20131272","journal-title":"Childs Nerv Syst"},{"issue":"11","key":"5218_CR21","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1007\/s11934-015-0550-6","volume":"16","author":"JT White","year":"2015","unstructured":"White JT et al (2015) Systematic review of urologic outcomes from tethered cord release in occult spinal dysraphism in children. Curr Urol Rep 16(11):78","journal-title":"Curr Urol Rep"},{"issue":"10","key":"5218_CR22","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1007\/s00381-012-1775-z","volume":"28","author":"V Wykes","year":"2012","unstructured":"Wykes V, Desai D, Thompson DN (2012) Asymptomatic lumbosacral lipomas\u2013a natural history study. Childs Nerv Syst 28(10):1731\u20131739","journal-title":"Childs Nerv Syst"},{"issue":"11","key":"5218_CR23","doi-asserted-by":"publisher","first-page":"1899","DOI":"10.1007\/s00381-017-3504-0","volume":"33","author":"K Yalt\u0131r\u0131k","year":"2017","unstructured":"Yalt\u0131r\u0131k K et al (2017) Management of concomitant scoliosis and tethered cord syndrome in non-spina bifida pediatric population. Childs Nerv Syst 33(11):1899\u20131903","journal-title":"Childs Nerv Syst"},{"issue":"4","key":"5218_CR24","doi-asserted-by":"publisher","first-page":"494","DOI":"10.3171\/jns.1981.54.4.0494","volume":"54","author":"S Yamada","year":"1981","unstructured":"Yamada S, Zinke DE, Sanders D (1981) Pathophysiology of \u201ctethered cord syndrome. J Neurosurg 54(4):494\u2013503","journal-title":"J Neurosurg"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-022-05218-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-022-05218-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-022-05218-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T09:06:27Z","timestamp":1654074387000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-022-05218-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,28]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["5218"],"URL":"https:\/\/doi.org\/10.1007\/s00701-022-05218-6","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,28]]},"assertion":[{"value":"15 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 April 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the regional ethical review board (2018\/1873\u201331). The procedures used in this study adhere to the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The ethical review board waived the need for informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors report no conflict of interest. AET is a consultant for Brainlab.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}