Treating difficult-to-diagnose tight filum terminale: our experience with four patients.

Tight filum terminale (TFT) is a general term for pathological conditions that result in abnormal tension on the spinal cord, pulling the conus medullaris caudally. Because symptoms can vary, we aim to review the usefulness of Komagata's criteria in our experience with four patients who had TFT that was missed in prior workups. We performed a retrospective review of the medical records of four patients who underwent resection of the filum terminale for TFT. A total of four patients underwent surgery. The patients' chief complaints were lower back pain, lower limb pain and numbness. All patients met the Komagata diagnostic criteria for TFT and also had neurological abnormalities of the upper limbs, such as numbness and pathological reflexes. We resected the filum terminale in all patients, and achieved resolution of their preoperative symptoms. Komagata's diagnostic criteria are seemingly useful for the diagnosis of TFT.