ArticleBrain & spine2026
Adult tethered cord syndrome associated with spina bifida occulta and a lipomatous filum terminale: case report and structured literature review.
Article in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Adult tethered cord syndrome (TCS) is uncommon and may be overlooked when chronic lumbosacral pain coexists with subtle occult dysraphism and urinary complaints. Research question: How should an adult patient with back pain, recurrent urinary tract infections, and imaging evidence of a low-lying conus with a lipomatous filum terminale be evaluated and managed? Material and methods: We report a 27-year-old woman with progressive low back and left leg pain, recurrent urinary tract infections, and detrusor overactivity. Computed tomography showed L5-S1 spina bifida occulta, and magnetic resonance imaging showed a low conus ending at L3/4 with a thickened lipomatous filum terminale. She underwent L5 laminectomy and microsurgical detethering with intraoperative neurophysiological monitoring. A structured literature review of adult TCS related to lipomatous filum, occult dysraphism, and urinary dysfunction was also performed. Results: The filum was thickened and fatty intraoperatively, with no evoked responses up to 1.5 mA before sectioning. After surgery, back and radicular pain resolved, urinary tract infections did not recur, no new neurological deficit developed, and the incision was well healed at 7 weeks. The adult literature shows that pain and urinary dysfunction are common presenting features and that detethering most consistently improves pain. Discussion and conclusion: Adult TCS should remain in the differential diagnosis for persistent low back pain with urinary dysfunction, even when neurological examination is normal and cutaneous stigmata are absent. In symptomatic adults, a low conus, lipomatous filum terminale, and spina bifida occulta should prompt consideration of detethering.
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