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Treating difficult-to-diagnose tight filum terminale: our experience with four patients
  1. Takashi Sato1,
  2. Yawara Eguchi2,
  3. Keigo Enomoto1 and
  4. Yasuaki Murata3
  1. 1Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
  2. 2Department of Orthopaedic Surgery, Center for Orthopaedic science medical innovation graduated school of medicine, Chiba University, Chiba, Chiba, Japan
  3. 3Department of Orthopaedic Surgery, Teikyo Daigaku Chiba Sogo Iryo Center, Ichihara, Chiba, Japan
  1. Correspondence to Dr Takashi Sato; holywarrs{at}


Tight filum terminale (TFT) is a general term for pathological conditions that result in abnormal tension on the spinal cord, pulling the conus medullaris caudally. Because symptoms can vary, we aim to review the usefulness of Komagata’s criteria in our experience with four patients who had TFT that was missed in prior workups. We performed a retrospective review of the medical records of four patients who underwent resection of the filum terminale for TFT. A total of four patients underwent surgery. The patients’ chief complaints were lower back pain, lower limb pain and numbness. All patients met the Komagata diagnostic criteria for TFT and also had neurological abnormalities of the upper limbs, such as numbness and pathological reflexes. We resected the filum terminale in all patients, and achieved resolution of their preoperative symptoms. Komagata’s diagnostic criteria are seemingly useful for the diagnosis of TFT.

  • pain (neurology)
  • spinal cord
  • orthopaedics
  • neurosurgery

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  • Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the BMJ case reports. Authorship contributions Category 1: Conception and design of study: TS, YE and YM; acquisition of data: TS, KE and YM; analysis and/or interpretation of data: TS, YE and YM; Category 2: Drafting the manuscript: TS, YE and YM; revising the manuscript critically for important intellectual content: TS, YE and YM; Category 3: Approval of the version of the manuscript to be published TS, YE, KE and YM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.