The Filum Disease – Definition (2)

“The Neuro-Cranio-Vertebral Syndrome caused by a congenital anomaly of an apparently normal Filum terminale, which however exerts a traction on the spinal cord and the entire nervous system”

We consider the “Filum Disease” to be the condition that is caused by an anomalous traction exerted by the filum terminale ligament on the spinal cord.

It finds its expression in form of different diseases which previously in medical history have been described as being independent from each other: the Arnold Chiari I Syndrome, Idiopathic Syringomyelia and Idiopathic Scoliosis, Platybasia, Basilar Invagination, Retroflexed Odontoid, Kinking of the brain stem and nocturnal Enuresis.

Furthermore, we believe that an excessively tight filum terminale can be a contributory cause for other conditions, as would be vertebral disk protrusions or herniations or vertebral multiple discopathy in general, cerebral vascular insufficiency, some hormonal alterations, cognitive alterations or mood states.  

One of the complications of the spinal cord traction arises, when the traction reaches a point where its force engages the cerebellar tonsils within the foramen magnum, in some cases this may cause an obstruction of the cerebrospinal fluid (CSF), causing a hydrocephalus. In the light of this new theory, the CSF hypertension is therefore revealed as a consequence, and not the origin, of Arnold Chiari I.

The Filum Disease is not associated with any important malformations of the nervous system or the vertebral spine by definition. In case of the existence of these kind of malformations, they would be attributable to other diseases; in case of a nervous system or spinal malformation in association with a descent of the cerebellar tonsils, this would be due to a Arnold Chiari II Syndrome. On the other hand, there are kinds of Filum Disease in which hardly any alterations or anomalies can be identified on tests like MRI, CT, X-Ray, Evoked Potential, etc.

The Filum Disease’s clinical expressions are bound to the different variables of one or more of the diseases that are included in the disease, totally or partially. This is why a clinical picture of a broad variety of symptoms and signs arises which is brought together in the definition of the "Neuro-Cranio-Vertebral Syndrome” (NCVS)

The diagnostic distinctions are of great importance as it is on their basis that decisions for surgical treatment are made. If we accept that all patients suffering from Arnold Chiari I Syndrome, Idiopathic Syringomyelia and Idiopathic Scoliosis are affected by the Filum Disease due to a shared etiopathogenic cause, there will be no more doubts in establishing the Sectioning of the Filum Terminale Surgery as the treatment of choice in order to stop the further evolution of any of these diseases.  

Historically, up to now, none of the mentioned diseases have been associated with what is defined as “tethered cord”, and therefore the sectioning was not indicated for their treatment.

Understanding the new definition of the disease in question is fundamental in order to spread the knowledge about the innovative treatment of the Sectioning of the Filum Terminale, and it should be based on this understanding that the diagnosis making process is approached so that patients do not find themselves losing precious time in the search for a solution to their problems.  

Given and considering the current controversy in the international theoretical and therapeutical debate on the conditions discussed in this post, the Filum System ® has been registered as a trademark, in an intent to ensure that the concept be taught as a entire set of diagnostic, treatment and patient care guidelines, as its effectiveness relies on the combination of all these aspects.