{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:36:18Z","timestamp":1760574978037,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: We report a prospective series of five patients with symptomatic cervicothoracic spinal cord tethering from prior surgical interventions for acquired and congenital spinal pathologies. Each patient demonstrated incidental radiographic evidence of a low-lying conus or a fatty\/thickened filum terminale (FT), suggesting concomitant symptomatic conus tethering as a potential contributor. Therefore, all underwent single-stage \u201ctandem detethering\u201d, consisting of microsurgical release of the cervicothoracic pathology followed by FT resection. Methods: Patients\u2019 charts were reviewed for preoperative presentation, imaging, intraoperative findings, surgical details, FT pathology, and six-month outcomes. Results: Preoperative tethering occurred at sites of prior interventions: (i) thoracic arachnoid cyst decompression after Chiari surgery, (ii) cervical lipomyelomeningocele repair, (iii) thoracic ependymoma resection, (iv) syringosubarachnoid shunt placement, and (v) laminectomies for recurrent syrinx. Lumbar MRI demonstrated a low-lying conus in two patients and a fatty\/thickened FT in four patients. Intraoperatively, all patients exhibited an abnormal FT (tight, fat-infiltrated, thickened, or dysplastic). No intraoperative complications or neuromonitoring abnormalities were observed. At six months, all patients demonstrated improvement in motor, sensory, pain, and urinary\/bowel symptoms. Complications included two pseudomeningoceles requiring repair and one case of recurrent cauda tethering following FT resection. Conclusions: In patients with symptomatic cervicothoracic tethering, a concomitant low-lying conus or pathological FT may contribute to symptomatology by perpetuating biomechanical stress and, if not surgically addressed, may limit neurological recovery. This concept provides a rationale for considering tandem detethering under such circumstances.<\/jats:p>","DOI":"10.3390\/jcm14207169","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T10:12:29Z","timestamp":1760523149000},"page":"7169","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tandem Detethering: A Novel One-Stage Approach Combining Cervicothoracic Cord Release Followed by Filum Terminale Sectioning"],"prefix":"10.3390","volume":"14","author":[{"given":"Natalie","family":"Amaral-Nieves","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brown University, 593 Eddy Street, APC 6 Building, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilija","family":"Sagaityte","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brown University, 593 Eddy Street, APC 6 Building, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6392-0643","authenticated-orcid":false,"given":"Belinda","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brown University, 593 Eddy Street, APC 6 Building, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shailen","family":"Sampath","sequence":"additional","affiliation":[{"name":"Vagelos College of Physicians and Surgeons, Columbia University, 630 W 168th Street, New York, NY 10032, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Sastry","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brown University, 593 Eddy Street, APC 6 Building, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prakash","family":"Sampath","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brown University, 593 Eddy Street, APC 6 Building, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9894-7723","authenticated-orcid":false,"given":"Petra M.","family":"Klinge","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brown University, 593 Eddy Street, APC 6 Building, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deus","family":"Cielo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brown University, 593 Eddy Street, APC 6 Building, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/foc.2004.16.2.7","article-title":"Pathophysiology of tethered cord syndrome: Correlation with symptomatology","volume":"16","author":"Yamada","year":"2004","journal-title":"Neurosurg. 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