Intraoperative neurophysiological monitoring during surgery for tethered cord syndrome.
OBJECTIVE
The tethered cord syndrome refers to a variety of lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Permanent or temporary neurological complications were reported following surgical release. In this report, peri- and postoperative results in cases with tethered cord syndrome that were followed by multimodal intraoperative neurophysiological monitoring (MIONM) methods are presented.


METHODS
An IONM system (Nicolet CR Endeavor) was used for monitoring during tethered cord surgery. Somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), direct nerve root/rootlet stimulation, free-run electromyography (EMG) and F-waves were used during tethered cord surgery of 10 cases to prevent possible nerve injuries.


RESULTS
MEP and SEP recordings did not change in any of the cases during surgery. The nervous tissue was identified and differentiated from connective tissue in three cases when motor responses were elicited with direct stimulation of nerve roots. None of the cases had neurological deficits following the operation.


CONCLUSIONS
Direct nerve root/rootlet stimulation should be one of the components of MIONM during surgery for tethered cord syndrome to prevent postoperative neurological deficits.
Gazi University, Department of Physical Medicine and Rehabilitation Ankara, Turkey. mbeyazova@gmail.com
Mehmet
M
Beyazova
Murat
M
Zinnuroglu
Hakan
H
Emmez
Kadir
K
Kaya
H Zerrin
HZ
Ozkose
M Kemali
MK
Baykaner
Zeynep
Z
Erden
Nurdan
N
Orucoglu
Gokhan Tuna
GT
Ozturk
Zeynep
Z
Erdogan
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D009436:Neural Tube Defects / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D013126:Spinal Nerve Roots / Q000502:physiology; D055815:Young Adult