Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Sydrome

Hael Abdulrazeq
* ,
Owen Leary
ORCID logo ,
Oliver Tang
,
Helen Karimi
ORCID logo ,
Abigail McElroy
,
Ziya Gokaslan
,
Michael Punsoni
,
John Donahue
,
Petra Klinge
Version 1 : Received: 16 December 2023 / Approved: 17 December 2023 / Online: 18 December 2023 (06:15:13 CET)

A peer-reviewed article of this Preprint also exists.

Abdulrazeq, H.; Leary, O.P.; Tang, O.Y.; Karimi, H.; McElroy, A.; Gokaslan, Z.; Punsoni, M.; Donahue, J.E.; Klinge, P.M. The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome. J. Clin. Med. 2024, 13, 6. Abdulrazeq, H.; Leary, O.P.; Tang, O.Y.; Karimi, H.; McElroy, A.; Gokaslan, Z.; Punsoni, M.; Donahue, J.E.; Klinge, P.M. The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome. J. Clin. Med. 2024, 13, 6.

Abstract

This study investigated the prevalence of embryonic and connective tissue elements in the filum terminale (FT) of patients with tethered cord syndrome (TCS), examining both typical and pathological histology. FT specimens from 288 patients who underwent spinal cord detethering from 2013-2021 were analyzed. Histopathological examination involved routine hematoxylin and eosin staining and specific immunohistochemistry when needed. Patient details were extracted from electronic medical records. The study found that 97.6% of FT specimens had peripheral nerves, and 70.8% had regular ependymal cell linings. Other findings included ependymal cysts and canals, ganglion cells, neuropil, and prominent vascular features. Notably, 41% showed fatty infiltration, and 7.6% had dystrophic calcification. Inflammatory infiltrates, an underreported finding, were observed in 3.8% of the specimens. The research highlights peripheral nerves and ganglion cells as natural components of the FT, with ependymal cell overgrowth and other tissues potentially linked to TCS. Enlarged vessels may suggest venous congestion due to altered FT mechanics. The presence of lymphocytic infiltrations and calcifications provides new insights into structural changes and mechanical stress in the FT, contributing to our understanding of TCS pathology.

Keywords

filum terminale; spinal cord disorders; tethered cord release; tethered cord syndrome

Subject

Biology and Life Sciences, Neuroscience and Neurology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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