The postoperative period in the Sectioning of the Filum Terminale according to the Filum System®

Published by ICSEB at 27 July, 2021

Dr. M. B. Royo Salvador started applying the minimally invasive Sectioning of the Filum Terminale in 1993. Until today, his neurosurgical team operated and carried out the follow-up according to the Filum System® method of over 1850 patients diagnosed of Filum Disease and Neuro-cranio-vertebral Syndrome, with Arnold-Chiari Syndrome type I, Idiopathic Syringomyelia, Idiopathic Scoliosis and other malformations and related conditions.

In the preoperative phase of our patients’ surgical programme, our specialists always emphasize the fact that the surgery eliminates the root cause of the disease and stops its progression or worsening. The intervention does not act directly on the consequences of the condition – i.e. the lesions of the nervous system, the symptoms and associated dysfunctions.

In most patients, from the immediate postoperative period, the improvement or disappearance of some symptoms can be appreciated, while others alleviate over time, in the following months or years. The same occurs in cases with postoperative rehabilitation and physical therapy: many patients present a functional progressive improvement as well, also from the first postoperative months.

On the other hand, there is a minority of patients who, in the first postoperative stage, do not observe any improvement in their clinical picture or in their autonomy, although they are maintaining a stable and not worsening condition. We wish to address ourselves especially to these patients, to prevent them from feeling discouraged and forgotten when comparing themselves with other patients who experienced a favourable outcome in the short or medium term.

First of all, each clinical picture is different and despite the possibility of presenting similar symptoms, they cannot be compared to those of another patient. Only the specialist will be able to assess the evolution of every single patient, through clinical and imaging check-ups.

Secondly, there are two types of lesions that determine symptoms: reversible and irreversible ones. Although, through the application of the treatment, the traction force that the Filum Terminale exerts on the entire nervous system is released, helping recovery also in the medium and long term, the nervous system will not be able to regenerate irreversible lesions, and recovery will be more limited.

Likewise, our specialists observe that initially some patients can experience improvements and, in some cases, even the disappearance of symptoms. However, later on, due to traumas, accidents, stress, medication, menstrual cycle alterations, physical efforts, there can be a relapse, with the recurrence of the clinical picture prior to surgery. When this happens, it usually takes some time before the patient can return to the postoperative stability. In general, once the associated condition is resolved, the patient improves again.

Finally, in some cases, apart from the Filum Disease for which surgery is performed, there can be one or more additional diagnosis with its own clinical picture, which can share some symptoms with the Filum Disease.

Obviously, after the Filum Disease surgery and throughout the postoperative evolution phases, it could be difficult to determine which symptoms depend on one condition and which ones on the other; or whether some symptoms do not improve because they are related to another diagnosis, or they worsen because it is necessary to treat the other condition. In these cases, our Doctors recommend consulting the corresponding specialist to specifically address and treat also the other active and comorbid cause.

To conclude, Dr. Royo’s team, thanks to their highly specialised expertise, confirm that the release of an overly tense Filum Terminale is the most effective way to help improve patients’ health conditions, even when the recovery may seem slower and more gradual, or other complicating factors intervene.

The Sectioning of the Filum Terminale according to the Filum System® method in general unequivocally improves the patients’ quality of life, with a significant remission of symptoms and a very satisfactory recovery in most cases. Furthermore, the treatment provides a good prognosis to patients whose health condition is severely compromised by the disease, despite not acting directly on the consequences of the Filum Disease.