Sudden appearance of new upper extremity motor function while performing neurophysiologic intraoperative monitoring during tethered cord release: a case report.
: Tethered cord syndrome occurs when the distal spinal cord or filum adheres to adjacent structures resulting in progressive sensorimotor deficits in the lower extremities, fecal and/or urinary incontinence, and musculoskeletal deformities. Tethering of the distal cord may be idiopathic, may be associated with an intraspinal abnormality such as a lipoma, but most commonly the distal spinal cord remnant is adherent to the area of the original dysraphism repair in patients with myelodysplasia. Surgery to untether the cord is indicated in patients with worsening pain symptoms, progressive limb deformity or spasticity, or before any acute correction of an associated spinal deformity. Neurophysiologic intraoperative monitoring is used to minimize the risk of inadvertent nerve root or spinal cord injury during the untethering procedure and to assess any changes in cord function at the time of an associated spinal deformity correction. We present a patient with a lumbar level myelodysplasia, Chiari II malformation, severe scoliosis, and tethered cord that underwent concurrent scoliosis correction and tethered cord syndrome surgery, who demonstrated immediate intraoperative improvement in neurophysiologic responses in a previously flaccid upper extremity after untethering. These monitoring changes correlated with clinical improvements noted by physicians and family postoperatively.


METHODS
Level IV.
Barley
Jessica Lauren
JL
Division of Clinical Neurophysiology, Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA. barley@musc.edu
Mooney
James F
JF
Glazier
Steven S
SS
Johnson
Tamara
T
Kornegay
Adam L
AL
Turner
Robert P
RP
Edwards
Jonathan C
JC
D001139:Arnold-Chiari Malformation / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D009048:Motor Skills; D009436:Neural Tube Defects / Q000503:physiopathology / Q000601:surgery*; D012600:Scoliosis / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*