Retethering of sectioned fibrolipomatous filum terminale in an adult: case report and review of the literature

Background contextRecurrent tethering of the spinal cord is a rare late complication after sectioning of a fibrolipomatous filum terminale that has only been reported in two pediatric cases.PurposeTo report adult-onset recurrent tethering of the spinal cord after surgical sectioning of a fibrolipomatous filum terminale and review the literature in an attempt to identify similar cases.Study design/settingThe study was designed to be a case report and literature review.MethodsA 21-year-old woman with a history of previous surgical repair for a tethered spinal cord secondary to a fibrolipomatous filum terminale presented with low back and right lower extremity pain, urinary frequency, and fecal incontinence. Progressive bladder and sphincter dysfunction was confirmed on urodynamic testing. Lumbar spine magnetic resonance imaging demonstrated a low-lying and dorsally positioned conus medullaris.ResultsThe patient underwent neurosurgical exploration of the previous site of sectioning with rerelease of the proximal fatty filum stump from dorsal dural adhesions. Postoperatively, her pain resolved, and her bowel and bladder control improved.ConclusionsSectioning of both abnormal and apparently normal fila has become a relatively common procedure in pediatric neurosurgery. As more children with this surgical history mature and present for neurosurgical consultation as adults, retethering must be considered in the differential diagnosis.