Tight Filum Terminale

Filum terminale is the thin fibrous structure that connects the lower spinal cord segments to the dorsal part of the first coccygeal vertebra. It serves as an elastic anchor to the spinal cord, giving the spinal cord a range of motion. The term “tight filum terminale” refers to a filum terminale that has an abnormal structure causing a tension on the lower segments of the spinal cord, resulting in a clinical entity that is called Tight Filum Termianle Syndrome. Occult tight film terminale syndrome is the term used to describe some cases of the typical clinical presentation of TFTS with normal imaging findings. Tissue necrosis, fibrosis, and fat infiltration of the filum terminale tissue is the hallmark of the pathogenicity of the abnormal filum terminale structure. The lumbosacral cord is pulled downward by an abnormal filum terminale structure, which impairs the oxidative metabolism of this region leading to tissue necrosis and neuronal cell death with subsequent neuronal dysfunction and the clinical signs of Tight Filum Termianle Syndrome. A set of neurological, dermatological, urological, and orthopedical symptoms can be presented. Magnetic resonance imaging (MRI) is the neuroimaging modality of choice for the diagnosis of TFTS. X-rays, computed tomography (CT scan), and urodynamic studies are also used in the evaluation of TFTS. Studies show that the preferred option for management in TFTS is untethering surgery, especially in symptomatic patients. TFTS is a syndrome that has a good prognosis. Several complications of untethering surgery were reported including CSF leakage, pseudomeningocele, re-tethering, and wound infection.