Surgical Treatment of Tethered Cord Syndrome by Release of Filum Terminalis: A Review

Tethered cord syndrome (TCS) is a disease caused by pathological fixation of the spinal cord, most commonly due to a thickened filum terminale, postoperative adhesions, or congenital dysraphism. Progressive neurological, urological, and orthopedic manifestations result from chronic cord traction and impaired vascular supply. Surgical detethering remains the standard treatment, with the classic intradural sectioning of the filum terminale being the most widely used technique. Recent developments, however, include minimally invasive tubular and endoscopic approaches, spinal column shortening procedures for recurrent or complex cases, and extradural detethering strategies. Each technique aims to reduce cord tension while minimizing postoperative complications, particularly cerebrospinal fluid leakage and retethering. This review summarizes the anatomical background, pathophysiology, and operative strategies for TCS, highlighting current evidence, technical nuances, and limitations of emerging minimally invasive and alternative approaches.