Structural & Mechanical Theory

….Tethering of the filum terminale causes a reduction in blood flow to the spinal cord, causing local tissue hypoxia that ultimately causes dysfunction of neuronal mitochondria, which can lead to cellular dysfunction and death. Furthermore, it seems apparent that the degree of traction on the spinal cord 1) correlates with cellular dysfunction, and 2) determines the permanence of this dysfunction after traction is released.
— Stetler et al., Neurosurgery Focus