Spine
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
The spinal cord is the specialised nerve tissue continuous with the medulla oblongata, enclosed circumferentially by the spinal meninges and suspended in the cerebrospinal fluid. It travels the vertebral column in the neural arch and terminates at L1/2 vertebral level in adults (L3/4 at birth) and measures about 45–50 cm in adults (Figure 4.3). Conus medullaris: tapered end of spinal cord at its terminationCauda equina (horse’s tail): bunch of spinal nerves at the conus medullaris (contains lumbar, sacral and coccygeal spinal nerves)Filum terminale: a thin strand of pia mater with no neural tissue that connects the conus medullaris to the coccyx.
Cerebral Palsy, Cerebellar Ataxia, AIDS, Phacomatosis, Neuromuscular Disorders, and Epilepsy
Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg in Essentials of the Adult Neurogenic Bladder, 2020
NLUTD in Duchenne muscular dystrophy (DMD) is unusual.73–78 Several reports73–75 showed various presentations, including UI or retention. The mechanism of NLUTD is unclear. Myopathic changes within the detrusor muscle would be expected to cause a flaccid bladder, while pathology in skeletal pelvic floor muscles could account for SUI.75 The upper motor neuron lesions are likely due to scoliosis, or complications of its surgical treatment, or due to altered expression of dystrophin on the CNS.74–75 NLUTD might be associated with fatty infiltration of the filum terminale. Sectioning of the filum terminale has resulted in recovery of urinary continence in a reported case.78
Spinal Cord Disease
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Intradural intramedullary (uncommon): Glial cell tumors (80% of intramedullary tumors): Ependymoma (many arise from filum terminale, approximately 50% of intramedullary primary tumors).Astrocytoma (mostly cervical).Oligodendroglioma (rare).
Primary ependymoma of the retropubic space in a male patient
Published in Ultrastructural Pathology, 2020
Elif Tasar Kapakli, Kemal Kosemehmetoglu, Figen Kaymaz, Bulent Akdogan, Mustafa Ozmen, Dilek Ertoy Baydar
The possible explanations for the histogenesis of ENE may depend on the tumor location. Since the sacrococcygeal ependymomas share some clinical, morphologic, and immunohistochemical features with myxopapillary ependymoma of filum terminale, it is believed that they may arise from ependymal rests which result from the incomplete regression of caudal cell mass.6,8,10–12 Similarly, other pelvic and extrapelvic ependymomas are believed to arise from ectopic rests of ependymal tissue or neometaplasia of the peritoneum, although some consider pure ovarian ependymomas as monodermal teratomas.1 Another hypothesis suggests that primordial germ cells are misdirected under the female hormones to form ependymoma, which also explains the female predominance in pelvic and extrapelvic lesions.13
Effect of untethering on occult tethered cord syndrome: a systematic review
Published in British Journal of Neurosurgery, 2022
Hamid Rezaee, Ehsan Keykhosravi
Nazar et al. reported that nearly half of their subjects experienced severe pain that markedly curtailed their physical and social activities. The pain onset was gradual in the majority of patients (83%), while in 25% of them, the pain progressed following an accident. Moreover, the pain was concentrated in the mid to upper lumbar region in the majority of patients (72%) and increased by lumbar flexion and prolonged sitting and standing. According to the main criterion of filum terminale was an increasing pain associated with lumbar flexion which is commonly accompanied by paravertebral muscle spasm. They reported that some patients routinely complained of superimposed sharp lightning pain along the spine with minimal lumbar flexion.16
The cystic dilation of ventriculus terminalis with neurological symptoms: Three case reports and a literature review
Published in The Journal of Spinal Cord Medicine, 2018
Syringomyelia should be clearly differentiated from a dilated ventriculus terminalis. The later occurs immediately cephalad to a normally located conus medullaris, is not associated with other dysraphic anomalies and is not related to history of trauma and surgical intervention and is non-progressive on follow-up MRI.4 According to Coleman et al.5 Stilling described a VT in 1859, and in 1875 Krause identified it as a true ventricle lined by ciliated ependymal cells. Krause named it the “fifth ventricle.” The development of the VT, or the fifth ventricle, can be considered a normal process of embryonal development.7 The origin of the VT can be traced to the embryonic development of the spinal cord, which can be subdivided into two stages: neurulation and canalization or retrogressive differentiation.8 Neurulation starts when the embryo is three-weeks old, and it is responsible for the formation of the neural tube through the progressive closure of the neural plate and its separation from the overlying ectoderm. The distal cord develops from a caudal cell mass that forms from the neuralepithelium and a notochord caudal to the primary neural tube. The caudal cell mass develops microcysts that coalesce to form an ependyma-lined tube that fuses with the central canal of the neural tube. With differentiation, the caudal end of the cell mass involutes, leaving a focal prominence in the ependyma-lined canal in the conus medullaris with a fibrous tail, which is the filum terminale.7 The VT appears after approximately 45 days (between the 43rd and the 48th day) after conception.8