{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:42:43Z","timestamp":1786124563975,"version":"build-2736575974"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2017,8,22]],"date-time":"2017-08-22T00:00:00Z","timestamp":1503360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND AND IMPORTANCE<\/jats:title>\n                    <jats:p>An adult patient was referred to our department for tethered cord syndrome. A lumbar magnetic resonance imaging showed a conus medullaris at the S2 level and the caudal part of the dural sac at the S3 level. We present a minimally invasive spine surgery procedure at the hiatus level for the treatment of tethered cord syndrome by the surgical section of the filum terminale externum, which avoids bone demolition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL PRESENTATION<\/jats:title>\n                    <jats:p>A 65-yr-old Caucasian man was referred for dysesthesia and a burning sensation in his lower limbs, which was both spontaneous and triggered by contact with his clothes. He had been unable to walk for 5 mo due to severe pain and stiffness in his legs. He suffered from minimal, occasional urinary incontinence and complained about muscle cramps in the supine position that prevented him from sleeping; he was only able to sleep when sitting in a wheelchair. Informed patient consent was obtained for the procedure; no opinion was requested from the Ethics Committee. A minimally invasive transhiatal approach with the sectioning of the superficial dorsal sacrococcygeal ligament without the removal of bone tissue allows access to the sacral canal, after which it is possible to section the filum terminale externum using a microsurgical technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>After a 6-mo follow-up period, the patient no longer had dysesthesia and pain in his legs, and was able to walk, albeit just a few meters. This surgical technique has the advantage of minimally invasive spine surgery, has few complications, and avoids risk of retethering.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opx188","type":"journal-article","created":{"date-parts":[[2017,8,22]],"date-time":"2017-08-22T03:59:48Z","timestamp":1503374388000},"page":"E1-E4","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Transhiatal Approach to Filum Terminale Externum Sectioning in Adult Patient With Tethered Cord Syndrome: Case Report"],"prefix":"10.1227","volume":"15","author":[{"given":"Vanni","family":"Veronesi","sequence":"first","affiliation":[{"name":"Section of Neurosurgery, Surgery of the Peripheral Nervous System, Local Health Authority of Romagna, \u201cDegli Infermi\u201d Faenza Hospital, Ravenna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Sacco","sequence":"additional","affiliation":[{"name":"Section of Neurosurgery, Surgery of the Peripheral Nervous System, Local Health Authority of Romagna, \u201cDegli Infermi\u201d Faenza Hospital, Ravenna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Mastronicola","sequence":"additional","affiliation":[{"name":"Pain Care Unit, Local Health Authority of Modena, New \u201cS. Agostino-Estense\u201d Hospital, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Staffa","sequence":"additional","affiliation":[{"name":"Section of Neurosurgery, Surgery of the Peripheral Nervous System, Local Health Authority of Romagna, \u201cDegli Infermi\u201d Faenza Hospital, Ravenna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,7]]},"reference":[{"issue":"(5)","key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s00701-005-0482-y","article-title":"Results of the section of the filum terminale in 20 patients with syringomyelia, scoliosis and Chiari malformation","volume":"147","author":"Royo-Salvador","year":"2005","journal-title":"Acta Neurochir (Wien)"},{"issue":"4","key":"bib2-20240909","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s10143-008-0140-x","article-title":"Surgery in adult onset tethered cord syndrome (ATCS): review of literature on occasion of an exceptional case","volume":"31","author":"Aufschnaiter","year":"2008","journal-title":"Neurosurg Rev"},{"issue":"140","key":"bib3-20240909","first-page":"523","article-title":"A new surgical treatment for syringomyelia, scoliosis, Arnold-Chiari malformation, kinking of the brainstem, odontoid recess, idiopathic basilar impression and platybasia","volume":"25","author":"Royo-Salvador","year":"1997","journal-title":"Rev Neurol"},{"issue":"6","key":"bib4-20240909","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1227\/NEU.0b013e31821246c6","article-title":"Symptomatic retethering of the spinal cord after section of a tight filum terminale","volume":"68","author":"Yong","year":"2011","journal-title":"Neurosurgery"},{"issue":"1","key":"bib5-20240909","doi-asserted-by":"crossref","first-page":"42","DOI":"10.3171\/2010.10.PEDS09550","article-title":"Retethering of transected fatty filum terminales","volume":"7","author":"Ogiwara","year":"2011","journal-title":"J Neurosurg Pediatr"},{"issue":"6","key":"bib6-20240909","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1159\/000353477","article-title":"Retethering in children after sectioning of the filum terminale","volume":"48","author":"Vassilyadi","year":"2012","journal-title":"Pediatr Neurosurg"},{"issue":"1","key":"bib7-20240909","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.wneu.2011.07.039","article-title":"Retethering after filum cutting","volume":"77","author":"Kestle","year":"2012","journal-title":"World Neurosurg"},{"issue":"1","key":"bib8-20240909","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.wneu.2011.05.017","article-title":"Outcome, reoperation, and complications in 99 consecutive children operated for tight or fatty filum","volume":"77","author":"Ostling","year":"2012","journal-title":"World Neurosurg"},{"issue":"4","key":"bib9-20240909","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1159\/000028719","article-title":"Recurrent tethering: a common long-term problem after lipomyelomeningocele repair","volume":"29","author":"Colak","year":"1998","journal-title":"Pediatr Neurosurg"},{"issue":"7","key":"bib10-20240909","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/PL00007291","article-title":"Secondary tethered cord syndrome in spinal dysraphism","volume":"16","author":"Ohe","year":"2000","journal-title":"Childs Nerv Syst"},{"issue":"9","key":"bib11-20240909","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s00381-009-0895-6","article-title":"Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty","volume":"25","author":"Samuels","year":"2009","journal-title":"Childs Nerv Syst"},{"issue":"1","key":"bib12-20240909","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2010.3.FOCUS1077","article-title":"Minimally invasive tethered cord release in adults: a comparison of open and mini-open approaches","volume":"29","author":"Potts","year":"2010","journal-title":"Neurosurg Focus"},{"issue":"2 suppl 1","key":"bib13-20240909","first-page":"70","article-title":"A novel minimally invasive technique for spinal cord untethering","volume":"60","author":"Tredway","year":"2007","journal-title":"Neurosurgery"},{"issue":"3","key":"bib14-20240909","first-page":"71","article-title":"Sectioning of filum terminale externum using a rigid endoscope through the sacral hiatus. 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