Relationship between sacrococcygeal dimples and filum terminale degeneration:a report of 343 cases
Objective To explore the relationship between sacrococcygeal dimples and filum terminale degeneration in children.Methods A total of 343 children who visited the Department of Neurosurgery of Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine from April 2015 to March 2020 with the main complaint of sacrococcygeal dimples who underwent MRI lumbar spine examination were included.Surgical treatment was performed for children with filum terminale degeneration found on MRI(MRI positive)or with obvious tethered cord symptoms despite negative MRI findings.The occurrence of filum terminale degeneration in children with sacrococcygeal dimples was retrospectively analyzed,and the differences in filum terminale degeneration in children with different imaging manifestations were analyzed.Results Among the 343 children,166(48.4％)were confirmed to have filum terminale degeneration by surgery.Preoperative MRI was positive in 152 cases(44.3％)and negative in 191 cases(55.7％).Among the 152 children with positive MRI,52 cases showed degeneration of the filum terminale in both sagittal and axial images,and 100 cases showed degeneration of the filum terminale only in axial images.Among the 191 children with negative MRI findings,14 cases(7.3％)underwent surgical exploration due to obvious symptoms of tethered cord,and degeneration of the filum terminale was found in all cases during the operation.Intraoperatively,the maximum diameter of the filum terminale in the group with positive sagittal and axial MRI images,the group with positive axial images only,and the group with negative MRI images was 3.58±1.17 mm,2.32±0.56 mm,and 2.04±0.37 mm,respectively,with statistically significant differences(P＜0.001).Postoperative pathology showed that among the 52 cases with positive MRI sagittal and axial images,50 cases(96.2％)had fatty degeneration and 2 cases(3.8％)had fibrofatty degeneration;among the 100 cases with positive axial images only,95 cases(95.0％)had fatty degeneration,4 cases(4.0％)had fibrofatty degeneration,and 1 case(1.0％)had fibrotic degeneration;among the 14 cases with negative MRI findings,7 cases had fatty degeneration,1 case had fibrofatty degeneration,and 6 cases had fibrotic degeneration;the differences in pathological types among the three groups were statistically significant(P＜0.001).None of the 166 children who underwent surgery had surgery-related nerve injury symptoms or cerebrospinal fluid leakage.Follow-up at 6 months post surgery showed that the symptoms of children with preoperative symptoms were significantly improved.Conclusions Children with sacrococcygeal dimples have a high probability of filum terminale degeneration.MRI axial scanning can help improve the positive detection rate of MRI.Filum terminale degeneration cannot be ruled out in patients with negative MRI findings.The detection rate of filum terminale degeneration on MRI is related to the diameter of the filum terminale and the pathological type.Filum terminale fiber degeneration is not easily detected by MRI.
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