{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T10:28:35Z","timestamp":1753439315658,"version":"3.30.1"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The role of prophylactic detethering a fibrofatty filum terminale (FFT) remains equivocal. Furthermore, long-term studies focusing on urological outcomes are sparse. The aims of this study were to present an institutional experience on the perioperative and long-term outcomes of FFT surgery and to assess for factors that contribute to postoperative clean intermittent catheterization (CIC).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This was a single-institution, retrospective study conducted over a 20-year period. Patients younger than 19 years of age who underwent surgery for FFT were included. Variables of interest included patient demographics, clinical presentation, radiological findings, postoperative complications, and long-term need for CIC. Outcomes were measured using the Necker functional score and modified Hoffer Functional Ambulation scale score at 3, 6, and 12 months postdischarge.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 164 surgeries were performed for FFT from 2000 to 2020. The median age at surgery was 1.1 years, and the mean follow-up duration was 8.3 years. There were 115 patients (70.1%) who underwent prophylactic-intent surgery and 49 patients (29.9%) who underwent therapeutic-intent surgery. The proportion of therapeutic-intent surgeries increased significantly with age percentiles (0\u201320th, 21.9%; 20th\u201340th, 9.1%; 40th\u201360th, 18.2%; 60th\u201380th, 36.4%; and 80th\u2013100th, 63.6% [p &lt; 0.001]). Thirty patients (18.3%) had an associated syndrome, the most common (n = 19, 11.6%) being VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities). Forty-eight patients (29.3%) had an associated malformation (anorectal anomaly = 37, urogenital anomaly = 16, and sacral anomaly = 3). Cutaneous manifestation was the most common presentation (n = 96, 58.5%), followed by lower-limb neurological deficits (n = 21, 12.8%). A low-lying conus was present in 36.0% of patients (n = 59), and 16.5% had an associated syrinx (n = 27). There were 26 patients (18.8%) with an abnormal preoperative urodynamic study. Three patients (1.8%) had postoperative complications that required repeat surgery. There were no cases of CSF leakage. One patient (0.6%) developed retethering requiring another surgery. Postoperative CIC was required in 11 patients (6.7%). Multivariable analyses showed that an abnormal preoperative urodynamic study (adjusted OR 5.5 [95% CI 1.27\u201323.9], p = 0.023) and having an intraspinal syrinx (adjusted OR 5.29 [95% CI 1.06\u201326.4], p = 0.042) were associated with the need for CIC.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The authors\u2019 results demonstrate that detethering surgery for FFT is a relatively safe procedure and can be performed prophylactically. Nonetheless, the risks of postoperative CIC should be emphasized during the preoperative counseling process.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.8.peds22103","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T11:10:33Z","timestamp":1669979433000},"page":"197-205","source":"Crossref","is-referenced-by-count":8,"title":["Fibrofatty filum terminale: long-term outcomes from a Singapore children\u2019s hospital"],"prefix":"10.3171","volume":"31","author":[{"given":"Jia Xu","family":"Lim","sequence":"first","affiliation":[{"name":"Neurosurgical Service, KK Women\u2019s and Children\u2019s Hospital, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Fong","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, KK Women\u2019s and Children\u2019s Hospital, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl","family":"Goh","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, KK Women\u2019s and Children\u2019s Hospital, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee Ping","family":"Ng","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, KK Women\u2019s and Children\u2019s Hospital, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khurshid","family":"Merchant","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, KK Women\u2019s and Children\u2019s Hospital, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C. Y.","family":"Low","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, KK Women\u2019s and Children\u2019s Hospital, Singapore;"},{"name":"Department of Neurosurgery, National Neuroscience Institute, Singapore;"},{"name":"Neuroscience Academic Clinical Program, SingHealth Duke-NUS, Singapore; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wan Tew","family":"Seow","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, KK Women\u2019s and Children\u2019s Hospital, Singapore;"},{"name":"Department of Neurosurgery, National Neuroscience Institute, Singapore;"},{"name":"Neuroscience Academic Clinical Program, SingHealth Duke-NUS, Singapore; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon Y. 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