Two cases of tight filum terminale associated with low back pain

<p>Introduction: Tight filum terminale (TFT) is a stretch-induced functional disorder of the spinal cord due to the fact that its caudal portion is anchored by an inelastic structure, and it has been reported as a potential cause of persistent low back pain and leg pain. TFT is often overlooked and untreated because standard imaging studies such as MRI do not reveal any abnormalities.</p><p>Case Report 1: 13-year-old boy. He presented with the onset of low back pain during exercise in the past two months. He had difficulty sitting due to the low back pain. A provocation test for spinal cord extension (TFT provocation test) was positive. CT myelography confirmed a tense filum terminale in both prone and supine positions. After surgical transection of the filum terminale, the low back pain improved, and subsequent TFT provocation test became negative.</p><p>Case Report 2: 47-year-old man. He developed low back pain after driving two months ago. The low back pain worsened with forward bending of the lumbar spine, and TFT provocation test was positive. Gait was unstable due to spasticity in the lower extremities. Although there were no abnormal findings in the cervical and thoracic spine, CT myelography revealed a tense filum terminale in both prone and supine positions. After surgical transection of the filum terminale, the low back pain improved, and there was a slight improvement in gait. TFT provocation test also became negative.</p><p>Conclusions: TFT should be considered as a potential diagnosis for low back pain, especially when standard imaging studies fail to identify any abnormalities.</p>