title: Tethered Cord Syndrome-A Study of the Short-Term Effects of Surgical Detethering on Markers of Neuronal Injury and Electrophysiologic Parameters.
abstract: OBJECTIVE
  Several studies have assessed clinical and radiologic outcomes after detethering of the cord for tethered cord syndrome (TCS). However, no data regarding the impact of detethering on the metabolism or electrophysiologic functioning of the cord are available. The aim of this study was to assess the changes in the cerebrospinal fluid (CSF) levels of markers of neuronal injury and alterations in the electrophysiologic functioning of the spinal cord after detethering.
  
  
  METHODS
  This prospective study included patients with congenital TCS. Patients underwent clinical assessment, magnetic resonance imaging, somatosensory evoked potentials (SSEP) study, and CSF biochemical analysis (to estimate lactate, glial fibrillary acidic protein, and S100B levels), before and 3 months after surgery. Clinical and radiologic outcomes were assessed. We studied changes in biochemical and electrophysiologic parameters before and after detethering as surrogate markers for the effects of this intervention.
  
  
  RESULTS
  Twenty-one patients were recruited over 2 years. Detethering led to clinical improvement in 75% of patients with motor deficits, 60% of patients with bladder symptoms, and 50% of patients with gait problems. At 3 months follow-up, 43% (median) of the preoperative vertical tethering was found to be corrected. There was significant reduction in CSF lactate, glial fibrillary acidic protein, and S100B levels as well as a significant decrease in the latencies of the SSEP waves 3 months after surgery.
  
  
  CONCLUSIONS
  Surgical detethering led to a reduction in the CSF levels of the markers of anaerobic metabolism and neuronal injury. There was also a reduction in the latencies of the SSEP waves, indicating better electrophysiologic functioning of the cord.
authors.affiliation: Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Ved Prakash
authors.initials: VP
authors.lastname: Maurya
authors.affiliation: Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Medha
authors.initials: M
authors.lastname: Rajappa
authors.affiliation: Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Wadwekar
authors.affiliation: Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Narayan
authors.affiliation: Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Barathi
authors.affiliation: Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. Electronic address: vensmad@gmail.com.
authors.forename: Venkatesh S
authors.initials: VS
authors.lastname: Madhugiri
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000134:cerebrospinal fluid; D002648:Child; D002675:Child, Preschool; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009436:Neural Tube Defects / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000503:physiopathology* / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Anaerobic metabolism; Cord ascent; Detethering; GFAP; Lactate; Neuronal injury; S100B; SSEP; Tethered cord syndrome