Simple Structure of
Peripheral Nervous System Surgery 
- Department of Neuroscience -

Local Health Authority of Romagna, Italy

Historical Hospital "Per gli Infermi" in Faenza (RA) Viale Stradone 9
Photo: Hall of Columns

OCCULT TETHERED CORD SYNDROME
unknown disease that is difficult to diagnose.

A 2020 study compared information from five data sources representing the most authoritative voices on rare diseases:
ORPHANET (online database of rare diseases and orphan drugs),
OMIM (Online Mendelian Inheritance in Man),
GARD (Genetic and Rare Diseases information centre),
DOID (Disease Ontology),
NCI Thesaurus (National Cancer Institute Thesaurus) (Haendel et al, Nature Review DrugDiscovery, 2020;19:77-78).
Given that 6,370 diseases are present in at least three of the databases above, 4,023 diseases are present only in single databases. Combining this information reveals a total number of 10,393 rare diseases, a number that other studies suggest may even be underestimated (Bamshad et al, Am J Hum Genet, 2019;105:448-355; Smith et al, iScience 2022;25:104698).
TETHERED CORD SYNDROME is present in databases in ORPHANET, GARD and NCI Thesaurus.
This pathology has a standard lumbar MRI as support for the clinical diagnosis. Dealing with OCCULT TETHERED CORD SYNDROME, WHICH IS NOT PRESENT IN THE ABOVE DATABASE, therefore the number of patients with this rare disease is underestimated.
The OCCULT TETHERED CORD SYNDROME is a clinical diagnosis based on the symptoms and the results of a medical evaluation that includes specific tests. The standard lumbar MRI is normal, but there is a particular lumbar MRI in the prone position which can support clinical diagnosis.
Lumbar MRI in the prone position has been studied in OCCULT TETHERED CORD SYNDROME in only two scientific papers, one by the Japanese colleagues of the University of Hiroshima (Use of prone position magnetic resonance imaging for detecting the terminal filum in patients with occult tethered cord syndrome. J Neurosurg Spine 18:76–84, 2013 ©AANS, 2013) and one by me (Prone Position Magnetic Resonance Imaging and Transhiatal Appro ach to Filum Terminale Externum Sectioning in Adolescents with Occult Tethered Cord Syndrome: Report of Four Cases. Pediatr Neurosurg 2020;55:432–438).
The OCCULT TETHERED CORD SYNDROME is therefore almost unrecognized in the medical community; to date, "only" 563 scientific papers have been published in the medical literature, compared to the 34,692 of the TETHERED CORD SYNDROME.
My patients are operated on with an innovative minimally invasive surgical technique under local anaesthesia, which I have been carrying out since 2010, which reduces the possible complications of traditional surgery to just cutting the skin while it does not present the various complications, sometimes clinically relevant, of classic surgery (for the detailed differences between minimally invasive surgery under local anaesthesia and traditional surgery under general anaesthesia see the dedicated page on my website by CLICK HERE).
The undersigned described this minimally invasive surgical technique under local anaesthesia for the first time in an international scientific journal: TECHNICAL CASE REPORT. Transhiatal Approach to Filum Terminale Externum Sectioning in Adult Patient With Tethered Cord Syndrome: Case Report. Operative Neurosurgery 15:E1–E4, 2018.
This minimally invasive surgery can also be applied in case of TETHERED CORD syndrome.
Surgical interventions are currently performed at the "Per gli Infermi" hospital in Faenza, previously also in the hospitals of Lugo and Cattolica.
The ways to get information are through my website, in which I recommend watching the pre and post-operative videos of patients treated for this pathology, the social media through which Italian and foreign patients, including my patients, share experiences or through the written testimonies (in Italian) of patients; see "Qsalute" web site
CLICK HERE FOR THE "Qsalute" WEBSITE OF THE NEUROSURGERY HOSPITAL OF FAENZA
CLICK HERE FOR THE "Qsalute" WEBSITE OF THE FAENZA HOSPITAL
CLICK HERE FOR THE "Qsalute" WEBSITE OF THE NEUROSURGERY HOSPITAL OF LUGO
I have operated on almost 400 Italian patients, 23 European patients, 5 American patients, and 1 African patient.
Patients affected by OCCULT TETHERED CORD SYNDROME are often young adults who present symptoms in the lower limbs, low back pain and difficulty in controlling the sphincters, urinary and sometimes also faecal (the various symptoms may not all be present at the same time), undergo to a standard lumbar MRI which is normal. They often don't have the correct diagnosis and are referred to a psychologist and psychiatrist.

TETHERED CORD SYNDROME
rare disease with difficult diagnosis

TETHERED CORD SYNDROME is present in some databases of rare diseases: ORPHANET, GARD and NCI Thesaurus.
This pathology has as a support standard lumbar MRI for clinical diagnosis.
The symptoms of patients affected by TETHERED CORD SYNDROME are the same as those of OCCULT TETHERED CORD SYNDROME; patients are often young adults who have lower extremity symptoms, low back pain and difficulty in controlling the sphincters, urinary one and sometimes also faecal one (various symptoms may not all be present at the same time).
The diagnosis of TETHERED CORD SYNDROME, although presenting less difficulty than OCCULT TETHERED CORD SYNDROME, nevertheless remains not without obstacles, as evidenced by the news (click in the green box below to read it) by a mother who managed, after consulting 17 different medical specialists, to have a diagnosis for her child only with ChatGPT.
Researchers are examining the effects of ChatGPT in medicine.
An article published in May in Frontiers in Artificial Intelligence states that the technology has both advantages and disadvantages for medicine: "The potential applications of ChatGPT in the field
medical range from identifying potential research topics assistance to professionals in clinical and laboratory diagnosis” and “Despite its potential applications, the use of ChatGPT and others
Artificial intelligence tools in medical writing also pose ethical and legal concerns".
Given this, news highlights how ChatGPT can help identify the possible presence of rare pathologies that are difficult to diagnose medically.
Diagnosis still has difficulties, more remarkable for the OCCULT TETHERED CORD SYNDROME.
In my experience of 13 years of minimally invasive surgery in this field, it has never happened that a patient contacted me after obtaining the suspicion of TETHERED CORD SYNDROME using Artificial Intelligence. Still, times change, and who knows if it will happen.
Today, Italian and foreign patients share their problems and experiences via social media; they inform themselves on my website and then contact me.

INNOVATIVE MINI INVASIVE SPINAL SURGERY: EXTRADURAL SECTION OF THE FILUM TERMINALE UNDER LOCAL ANESTHESIA
FOR THE TREATMENT OF
TETHERED CORD SYNDROME AND
OCCULT TETHERED CORD SYNDROME

A small skin incision is sufficient for the minimally invasive surgical approach under local anaesthesia to the sacral spinal canal through the sacral hiatus.

PRE AND POSTOPERATORY VIDEOS

SURGERY: INNOVATIVE MINIMALLY INVASIVE SURGERY OF THE EXTRADURAL SECTION OF THE FILUM TERMINALE UNDER LOCAL ANAESTHESIA: the duration of the operation is about 25 minutes; after an hour, the patient can walk again, discharged from the hospital the day after the surgery (SEE DEDICATED PAGE WITHIN THIS WEBSITE).

PATHOLOGIES: tethered cord syndrome and occult tethered cord syndrome may be associated with Low Lying Cerebellar Tonsils (LLCT) and Chiari malformation. 


SYMPTOMS: most symptoms are usually subjective. Symptoms in the lumbar region and lower limbs are rarely objective and do not allow regular walking.


We filmed patients with walking disorders before and after our innovative minimally invasive surgery under local anaesthesia, documenting the incredible and immediate benefits.

CASE 1. 38 year old woman.
Occult tethered cord syndrome.


CASE 2. 37 year old woman.
Occult tethered cord syndrome.

CASE 3. 48 year old man.
Occult tethered cord syndrome.

CASE 4. 39 year old woman.
Tethered cord syndrome (L2) and Low-Lying (1 to 4 mm) Cerebellar Tonsils (LLCT).

CASE 5. 33 year old woman.
Occult tethered cord syndrome, Ehlers Danlos syndrome, fibromyalgia and small fiber neuropathy.

CASE 6. 24 year old woman.
Occult tethered cord syndrome, Low-Lying (1 to 4 mm) Cerebellar Tonsils (LLCT) and dorsal hydromyelia.

CASE 7. 13 year old girl.
Occult tethered cord syndrome, cervical and dorsal hydromyelia, orthostatic tremor.

CASE 8. 38 year old woman.
Tethered cord syndrome (L2) with fatty filum terminale.

CASE 9. 55 year old woman.
Occult tethered cord syndrome.

CASE 10. 44 year old woman
Tethered cord syndrome (L2) in Chiari malformation type I, cervical and dorsal syringomyelia.

CASE 11. 45 year old woman.
Occult tethered cord syndrome in Chiari malformation type I.

CASE 12. 31 year old woman.
Occult tethered cord syndrome and Low-Lying (1 to 4 mm) Cerebellar Tonsils (LLCT).

CASE 13. 15 year old girl.
Occult tethered cord syndrome.

OUR RECENT SCIENTIFIC PAPER

Below you can read abstracts of the scientific papers published by us in international journals of neurosurgery, "OPERATIVE NEUROSURGERY" and "PEDIATRIC NEUROSURGERY" (NOT OPEN ACCESS JOURNAL), describing FOR THE FIRST TIME:

- The minimally invasive surgery under local anaesthesia of section of the filum terminale externum for the treatment of tethered cord;

- The innovative diagnostic-surgical protocol which involves the association between prone lumbar magnetic resonance and the minimally invasive surgery with the section of the filum terminale externum under local anaesthesia for the treatment of the occult tethered cord.

See the dedicated pages within the website to associate the tethered cord or occult tethered cord with the low lying cerebellar tonsils (LLCT) or the Chiari malformation.

INNOVATIVE Minimal Incision Microsurgery (MIMS) SURGICAL TECHNIQUE DESCRIBED FOR THE FIRST TIME and published on the prestigious American international scientific journal "operative neurosurgery"


FILUM TERMINALE EXTERNUM SECTIONING

Minimal Incision Microsurgery (MIMS) surgical technique to filum terminale externum sectioning is performed in local anesthesia by means of a small skin incision of about 4 centimeters.

This surgical technique has been performed by us since 2010, we have operated about 400 Italian patients, 24 patients residing abroad including 4 on the American continent.

For more information visit the dedicated pages on this website INNOVATIVE SURGERY: FILUM TERMINALE EXTERNUM SECTIONING IN LOCAL ANESTHESIA.

LUMBAR MRI IN PRONE POSITION
and minimally invasive
FILUM TERMINALE EXTERNUM SECTIONING
under local anaesthesia in
OCCULT TETHERED CORD

In 2020 were published in the scientific journal Pediatric Neurosurgery our innovative protocol. It involves the association between lumbar MRI in the prone position and minimally invasive surgery of the filum terminale extradural (externum) section under local anaesthesia.

We described this protocol for the first time in the international medical scientific literature. 

The italian patients operated with this protocol are generally adult patients, and to date, they are about 400, the adolescent patients operated on have been the subject of the aforementioned scientific work. 
In adult patients, the occult tethered cord can present itself as the only pathology or association with the presence of the tonsils slightly descended cerebellar, 0-4 mm (LLCT), or Chiari malformation.

WHO WE ARE

We are a team of neurosurgeons who perform surgery for degenerative spine diseases and tethered cord and occult tethered cords. We also perform surgical treatment for peripheral nervous system pathologies such as traumatic lesions, entrapment and tumours.

INNOVATIVE SURGERY WE PERFORM:
-VERONESI Vanni MD: Minimally invasive surgical treatment in local anaesthesia of sectioning of extradural filum terminale for the treatment of the tethered cord and occult tethered cord, pure or in association with Chiari malformation type I.

- SACCO Carlo MD: Surgical treatment of "nerve transfer" in quadriplegic patients to resume the use of the hands.

CONTACT US

Italian patients can book a neurosurgical visit in freelance with Veronesi Vanni MD by calling the toll-free number 800 00 44 88 of the CupTel AUSL of Romagna from Monday to Friday from 8 to 18, Saturdays and days before public holidays from 8 to 13.
Alternatively, reservations for medical visits can be made with the Electronic Health Record.

The toll-free number 800 00 44 88 is not active for those calling from outside Italy.
Foreign patients who want to book a medical appointment can send a message by clicking in the GREEN box below, and they will receive the appropriate information.

The outpatient clinic for medical examinations is inside the "per gli Infermi" hospital in Faenza in Viale Stradone, 9.

ABOUT US: PATIENT REVIEWS

Qsalute is the Italian portal dedicated to Italian healthcare with patient reviews and opinions on hospitals, doctors, and patient discussions.

To read the reviews of the patients treated at the Faenza Hospital on the Qsalute website, click on the GREEN box below for the "FAENZA HOSPITAL NEUROSURGERY" page.

Other reviews can be read on the "HOSPITAL FAENZA" page on the Qsalute website by clicking here
https://www.qsalute.it/ospedale-di-faenza/
The reviews of patients previously treated at the Hospital of Lugo (RA) (the previous site of our surgical activity) are on the page "NEUROSURGERY LUGO HOSPITAL", to read click on the following link
https://www.qsalute.it/neurochirurgia-ospedale-lugo/

The information contained on this site is intended for informational use only, not promotional and not a substitute for a medical visit or any therapies in progress.

The information contained on this site is provided in compliance with articles 55, 56 and 57 dictated in the matter by the Medical Deontology Code of the NATIONAL FEDERATION OF ORDERS OF SURGICAL DOCTORS AND DENTISTS, 18 May 2014 and the related GUIDELINES - ORDER OF SURGICAL DOCTORS AND OF THE DENTISTS OF THE PROVINCE OF FORLÌ - CESENA Forlì 13 June 2007. Updated on 21/12/2010. Authorization of the Medici Order of Forlì-Cesena required.
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LAST UPDATE 1ST FEBRUARY 2024