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 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.
A small skin incision is sufficient for the minimally invasive surgical approach under local anaesthesia to the sacral spinal canal through the sacral hiatus.
LAST UPDATE 1ST FEBRUARY 2024
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