Management of Tight Filum Terminale Syndrome With Special Emphasis on Normal Level

Editorial Comment: A number of neurosurgeons and pediatric urologists believe that certain children with so-called nonneuropathic neuropathic bladder may be incontinent due to the neurological sequela of an occult tethered spinal cord. These authors report on 13 children who underwent incision of the filum terminale in hopes of relieving incontinence, despite a normal location of the conus on lumbosacral magnetic resonance imaging. All of these children had progressive incontinence associated with detrusor hyperreflexia. Initial continence followed surgery in 12 patients but in more than half bladder hyperreflexia recurred within a month postoperatively. The surgical complications are not addressed and no apparent benefit resulted. This study, despite the small number of children and short followup, should discourage surgeons from recommending neurosurgery in children with a normally positioned conus. Douglas A. Canning, M.D.