{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:10:40Z","timestamp":1772827840062,"version":"3.50.1"},"reference-count":76,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>There is significant evidence in the literature and decades of practice experience that support filum terminale sectioning as an effective intervention to improve the symptoms of simple tethered cord (sTC). The diagnosis of sTC and indications for sTC surgery vary widely across the US and Canada, although the overall incidence of sTC surgery has been increasing across the US. This study sought to create and evaluate an evidence-based algorithm for the management of sTC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>An institutional standard for sTC management was established, based on an evidence-based medicine analysis of 93 papers from the literature. A prospective, IRB-approved study of all patients treated with these strictly delimited indications in 2019 was undertaken. Demographic, clinical, diagnostic, consultative, and outcome data were collected for all patients. Operated patients were seen at 6 weeks and 6 months for follow-up. Postoperative outcomes were recorded on a 4-point ordinal scale (worse, same, better, resolved) for analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Seven hundred twenty-nine unique patients were evaluated for possible sTC in 1 calendar year. One hundred fifty-one operations were performed. Two minor complications were noted (surgical wound breakdown and upper extremity deep vein thrombosis). All operated patients were clinically symptomatic, 79% of whom had 3 or more symptoms of sTC syndrome. Patients were seen by 3 or more subspecialists before surgery in 60% of the cases; no patient had fewer than 2 subspecialists involved in diagnosis. Postoperative results recorded by neurosurgery were strongly concordant with results observed by consultants. Significant improvement of symptomatic sTC was found across all symptoms (bladder\/bowel\/back pain\/leg pain\/gait\/headache\/tone) in the majority of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Filum terminale release for patients with sTC is a low-morbidity, high-impact intervention that can be beneficial to many children. A standardized set of operative indications driven by a multidisciplinary, evidence-based algorithm for sTC had high accuracy in identifying patients who benefit from a filum terminale release.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.peds24457","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T23:13:39Z","timestamp":1751066019000},"page":"330-342","source":"Crossref","is-referenced-by-count":0,"title":["Application and outcomes of a standardized, evidence-based institutional approach to simple tethered cord management"],"prefix":"10.3171","volume":"36","author":[{"given":"Thomas M.","family":"Moriarty","sequence":"first","affiliation":[{"name":"Divisions of Pediatric Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William C.","family":"Gump","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian S.","family":"Mutchnick","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joy","family":"Comingore","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis S.","family":"Peppas","sequence":"additional","affiliation":[{"name":"Pediatric Urology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eran","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Pediatric Urology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey T.","family":"White","sequence":"additional","affiliation":[{"name":"Pediatric Urology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin R.","family":"Sizemore","sequence":"additional","affiliation":[{"name":"Pediatric Urology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen K.","family":"Moeller","sequence":"additional","affiliation":[{"name":"Pediatric Radiology, Norton Children\u2019s Hospital, Norton Healthcare, Louisville; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Tethered cord syndrome: a review of the literature from embryology to adult presentation","volume":"29","author":"Hertzler DA II","year":"2010","unstructured":"Hertzler DA II, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2010;29(1):E1."},{"key":"b2","series-title":"Tethered Cord Syndrome in Children and Adults","first-page":"5","article-title":"Normal spinal cord development and the embryogenesis of spinal cord tethering malformations","author":"Dias MS","year":"2010","unstructured":"Dias MS, Rizk EB. Normal spinal cord development and the embryogenesis of spinal cord tethering malformations. In: Yamada BS, ed. Tethered Cord Syndrome in Children and Adults. 2nd ed. Thieme;2010:5-18."},{"issue":"3","key":"b3","series-title":"J Bone Joint Surg Am","first-page":"711","article-title":"The filum terminale syndrome (the cord-traction syndrome)","volume":"35-A","author":"Garceau GJ","year":"1953","unstructured":"Garceau GJ. The filum terminale syndrome (the cord-traction syndrome). 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Thieme; 2010:110-113."},{"key":"b6","series-title":"Youmans and Winn Neurological Surgery","first-page":"1850","article-title":"Tethered spinal cord: fatty filum terminale, meningocele manque, and dermal sinus tracts","author":"He L","year":"2015","unstructured":"He L, Tubbs RS, Wellons JC. Tethered spinal cord: fatty filum terminale, meningocele manque, and dermal sinus tracts. In: Winn HR, ed. Youmans and Winn Neurological Surgery. Elseiver;2015:1850-1855."},{"issue":"3","key":"b7","series-title":"Neurourol Urodyn","first-page":"890","article-title":"Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children\u2019s continence society","volume":"37","author":"Tuite GF","year":"2018","unstructured":"Tuite GF, Thompson DNP, Austin PF, Bauer SB. Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children\u2019s continence society. Neurourol Urodyn. 2018;37(3):890\u2013903."},{"issue":"7","key":"b8","series-title":"J Ark Med Soc","first-page":"328","article-title":"Diagnosis and management of the tethered cord syndrome","volume":"89","author":"Boop FA","year":"1992","unstructured":"Boop FA, Russell A, Chadduck WM. Diagnosis and management of the tethered cord syndrome. J Ark Med Soc. 1992;89(7):328\u2013331."},{"issue":"2","key":"b9","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Tethered cord syndrome in children: a review","volume":"23","author":"Bui CJ","year":"2007","unstructured":"Bui CJ, Tubbs RS, Oakes WJ. Tethered cord syndrome in children: a review. Neurosurg Focus. 2007;23(2):E2."},{"issue":"1","key":"b10","series-title":"World Neurosurg","first-page":"187","article-title":"Outcome, reoperation, and complications in 99 consecutive children operated for tight or fatty filum","volume":"77","author":"Ostling LR","year":"2012","unstructured":"Ostling LR, Bierbrauer KS, Kuntz C IV. Outcome, reoperation, and complications in 99 consecutive children operated for tight or fatty filum. World Neurosurg. 2012;77(1):187\u2013191."},{"issue":"5","key":"b11","series-title":"J Neurosurg Pediatr","first-page":"559","article-title":"Filum terminale lipomas: imaging prevalence, natural history, and conus position","volume":"13","author":"Cools MJ","year":"2014","unstructured":"Cools MJ, Al-Holou WN, Stetler WR Jr,  Filum terminale lipomas: imaging prevalence, natural history, and conus position. J Neurosurg Pediatr. 2014;13(5):559\u2013567."},{"issue":"3","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"255","article-title":"Clinical significance of imaging and histological characteristics of filum terminale in tethered cord syndrome","volume":"13","author":"Thompson EM","year":"2014","unstructured":"Thompson EM, Strong MJ, Warren G, Woltjer RL, Selden NR. Clinical significance of imaging and histological characteristics of filum terminale in tethered cord syndrome. J Neurosurg Pediatr. 2014;13(3):255\u2013259."},{"issue":"6","key":"b13","series-title":"Childs Nerv Syst","first-page":"309","article-title":"Occult spinal dysraphism in children: need for early neurosurgical referral","volume":"7","author":"O\u2019Neill P","year":"1991","unstructured":"O\u2019Neill P, Singh J. Occult spinal dysraphism in children: need for early neurosurgical referral. Childs Nerv Syst. 1991;7(6):309\u2013311."},{"issue":"2 Pt 2","key":"b14","series-title":"J Urol","first-page":"754","article-title":"The effects of delayed diagnosis and treatment in patients with an occult spinal dysraphism","volume":"154","author":"Satar N","year":"1995","unstructured":"Satar N, Bauer SB, Shefner J, Kelly MD, Darbey MM. The effects of delayed diagnosis and treatment in patients with an occult spinal dysraphism. 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Semin Pediatr Neurol. 1997;4(3):192\u2013208."},{"issue":"2","key":"b17","series-title":"Pediatr Neurosurg","first-page":"58","article-title":"Occult tight filum terminale syndrome: comments on the paper by Wehby et al","volume":"40","author":"McClone D","year":"2004","unstructured":"McClone D. Occult tight filum terminale syndrome: comments on the paper by Wehby et al. Pediatr Neurosurg. 2004;40(2):58."},{"issue":"2","key":"b18","series-title":"Pediatr Neurosurg","first-page":"51","article-title":"Occult tight filum terminale syndrome: results of surgical untethering","volume":"40","author":"Wehby MC","year":"2004","unstructured":"Wehby MC, O\u2019Hollaren PS, Abtin K, Hume JL, Richards BJ. Occult tight filum terminale syndrome: results of surgical untethering. 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J Neurosurg. 2006;104(5)(suppl):309\u2013313."},{"issue":"4 Pt 2","key":"b25","series-title":"J Urol","first-page":"1183","article-title":"Filum section for urinary incontinence in children with occult tethered cord syndrome: a randomized, controlled pilot study","volume":"195","author":"Steinbok P","year":"2016","unstructured":"Steinbok P, MacNeily AE, Hengel AR,  Filum section for urinary incontinence in children with occult tethered cord syndrome: a randomized, controlled pilot study. J Urol. 2016;195(4 Pt 2):1183\u20131188."},{"issue":"5)(suppl","key":"b26","series-title":"J Neurosurg","first-page":"305","article-title":"Occult tethered cord syndrome: not an indication for surgery","volume":"104","author":"Drake JM","year":"2006","unstructured":"Drake JM. Occult tethered cord syndrome: not an indication for surgery. 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