# Filum terminale transection in pediatric SCIWORA with tight filum terminale: a case series and literature review

## TL;DR

This study explores how tight filum terminale may cause spinal cord injuries in children with no visible radiographic damage and shows that a minimally invasive surgery can improve neurological outcomes.

## Contribution

The study introduces early surgical intervention for tight filum terminale as a potential treatment for pediatric SCIWORA.

## Key findings

- All four pediatric patients with SCIWORA and tight filum terminale underwent successful minimally invasive surgery.
- Two patients fully recovered within three months, one showed significant improvement, and one remained stable.
- Early surgery may relieve spinal cord ischemia and hypoxia caused by tight filum terminale.

## Abstract

To investigate the role of tight filum terminale (TFT) in pediatric spinal cord injury without radiographic abnormality (SCIWORA) following low-energy trauma and to evaluate the efficacy of minimal invasive interlaminar approach (MIIA) for filum terminale transection in treating these patients. The study aims to determine whether early surgical intervention can improve neurological outcomes in this specific patient population.

This retrospective case series included four pediatric patients with SCIWORA and concurrent TFT treated at Women and Children's Hospital of Ningbo University from December 2022 to May 2024. The patients underwent MIIA for filum terminale transection. We retrospectively analyzed the medical records, clinical courses, presentations, and treatment strategies for these patients.

All patients in this case series showed evidence of TFT following low-energy trauma. All patients underwent MIIA for filum terminale transection and intraspinal canal exploration due to progressive neurological impairment. None had received steroid treatment. Postoperatively, none experienced further neurological deterioration or complications. Two patients achieved complete resolution of preoperative symptoms within three months, one showed significant neurological improvement, and one had stable neurological status without further worsening.

TFT might be the etiology of SCIWORA in children after suffering from low-energy injuries. Performing filum terminale transection as early as possible after the occurrence of SCIWORA complicated by tight filum terminale in children might be beneficial for relieving the state of spinal cord ischemia and hypoxia caused by longitudinal traction of the spinal cord as early as possible and facilitating the recovery of neurological injuries.