Thickened Filum Terminale

The filum terminale is a delicate, thread-like structure at the end of the spinal cord, which helps stabilize the spinal cord in the spinal canal. A thickened filum terminale is an abnormal condition where this structure becomes fibrous, fat-infiltrated, or unusually thick, resulting in tethering of the spinal cord. This condition is a form of occult spinal dysraphism, and if left untreated, it can lead to tethered cord syndrome, causing progressive neurological, orthopedic, and urological problems in children. Early diagnosis and microsurgical detethering are key to preventing irreversible spinal cord damage. 🌍 Bangladesh Perspective: A Hidden but Treatable Condition In Bangladesh, thickened filum terminale often remains undetected due to lack of awareness, limited availability of MRI in rural areas, and misattribution of symptoms to developmental delay or cerebral palsy. Many children present late with weakness, gait disturbance, or bladder dysfunction. Through early diagnosis, advanced imaging, and surgical expertise, Dr. Md. Nafaur Rahman and his team at NINS and Bangladesh Paediatric Neurocare Centre are helping children with this condition recover functional independence and avoid long-term disability. 🧬 Causes and Pathophysiology Congenital developmental anomaly in which the filum terminale is fatty, thickened, or less elastic Leads to traction on the lower end of the spinal cord (conus medullaris) Results in impaired blood supply, neural dysfunction, and spinal cord stretching during growth A normal filum terminale measures <2 mm in thickness; anything greater is considered abnormally thickened, particularly if accompanied by neurological symptoms. 🧒 Clinical Features in Children Symptoms may be subtle at first and worsen with age and growth: Progressive weakness or stiffness in the lower limbs Abnormal gait, tiptoe walking, or dragging of feet Foot deformities (clubfoot, high arches) Loss of bladder or bowel control Back pain or stiffness Scoliosis or spinal curvature Delay in achieving motor milestones In some cases, an overlying skin stigmata such as a dimple, hairy patch, or skin tag over the lower back may be visible. 🔍 Diagnostic Evaluation 🧠 MRI of Lumbosacral Spine Gold standard test Shows low-lying conus medullaris (below L2) Detects fatty or thickened filum terminale 🔬 Urodynamic Studies Assess bladder involvement if urinary symptoms are present 🧪 Neurological Examination Baseline motor, sensory, and reflex evaluation 🛠️ Treatment: Surgical Detethering The primary treatment is microsurgical sectioning of the thickened filum terminale, a relatively safe and effective procedure that relieves spinal cord tension. ✂️ Surgical Objectives: Release tethered spinal cord Prevent progression of neurological symptoms Preserve existing motor and bladder function Performed under microscopic guidance, often as a minimally invasive procedure 🔄 Prognosis & Follow-Up Excellent outcome if performed early, especially before symptoms become severe Children often show improvement in gait, strength, and bladder control Periodic follow-up with neurological, urological, and orthopedic evaluations MRI may be repeated postoperatively to monitor for retethering 👨‍⚕️ Why Choose Dr. Md. Nafaur Rahman? Highly experienced in managing occult spinal dysraphism and tethered cord syndrome Performs microsurgical detethering with precision and safety Offers multidisciplinary follow-up including neurology, urology, and physiotherapy Treats children from all over Bangladesh at NINS and Bangladesh Paediatric Neurocare Centre 📞 For Consultation or Surgery Dr. Md. Nafaur Rahman Assistant Professor, Department of Pediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS) Chief Consultant, Bangladesh Paediatric Neurocare Centre 📞 Appointments & Referrals: 01912988182 | 01607033535 🌐 Website: www.neurosurgeonnafaur.com