Removal of the bony or fibrous septum and intradural lipoma and sectioning of the fatty filum terminale are required for effective detethering. Careful lipoma debulking, which can be facilitated with a CO2 laser, must be performed while developing surgical planes and minimizing tension on the tethered cord. https://thejns.org/doi/10.3171/CASE25691.
Baumgartner et al. (2026) studied this question.