We have always wondered a little bit about what a Fatty Filum is. If you recall, years ago, we went in for a tethered cord release on KP. After surgery, the neurosurgeon came back and said “the good news is that his cord was not tethered. He just had a fatty filum, so we got in there and cleaned that all up.” And that was all that was said about that. We figured that it may have ended up being an unnecessary surgery, but at least we were proactive.
I have searched for the term a couple of times since then, and never really got a lot of answers, so I just dismissed it. The problem was fixed, no need to really worry about it. Someone mentioned a tethered spinal cord on one of the boards I’m on, and it prompted that little feeling in the back of my head asking what IS a fatty filum?
After searching for it again, I finally got a clear definition including implications and wow. It just blew me away. You really should hear the tone of voice we use when we respond to doctors about that particular surgery “no, we thought he had a tethered cord but it turned out he just had a (?)fatty filum (?)”. That is just about the only part of KP’s medical condition that we have ever been unsure of or not understood completely, and we always just blow it off. I have always treated it like the neurosurgeon dealt with the fatty filum because he happened to be in there anyway, so he might as well do something. Doctors must think we’re idiots, because here is what I found today:
“The filum terminale is like a thin elastic band, about 8 inches long. At the top, it is formed from one of the layers of tissue surrounding your spinal cord, and extends from the bottom of your spinal cord to the tip of your tail bone. The outside of the "elastic band" has a few nerve fibres sticking to it.
The filum terminale works as an anchor for the spinal cord. For people with normal anatomy, the filum stretches when they bend over to allow the spinal cord to move up in the spinal column and then goes back to normal length when the person straightens up and gently pulls the spinal cord back to its normal position.
When the filum is fat-filled, fibrous and tight, it will not allow the spinal cord to move up and down within the spinal column, and so the spinal cord and the nerves end up being stretched instead of the filum. In most people this causes nerve damage".
Everybody has a filum terminale; it is a threadlike piece of tissue that connects the end of the spinal cord to the sacral end of the spinal canal in the pelvic area. In patients with a thickened filum (defined as more than 2 mm in diameter) [Yundt, 1997], the filum is shorter or lower-lying than normal and is thickened with fatty or fibrous tissue. This abnormality causes the filum to become relatively inelastic (a bit like a rope or cord, rather than an elastic band) and the spinal cord becomes tethered at an abnormally low level, thereby giving rise to the recognised signs and symptoms of a tethered spinal cord”
Yep. We are i-d-i-o-t-s. We are incredibly lucky and blessed idiots, but we’re still idiots. This doesn’t change KP’s outcome. This part of him got fixed and no complications are expected. It has just hit me that we didn’t just dodge a bullet, we dodged a big ole missile that we didn’t even know had been fired.
