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The value of intraoperative neurophysiological monitoring in tethered cord surgery
- Source :
- Child's Nervous System, CHILDS NERVOUS SYSTEM, 27(9), 1445-1452. SPRINGER
- Publication Year :
- 2011
- Publisher :
- Springer-Verlag, 2011.
-
Abstract
- Purpose The value of intraoperative neurophysiological monitoring (IONM) with surgical detethering in dysraphic patients has been questioned. A retrospective analysis of our series of 65 patients is presented with special focus on technical set-up and outcome. Methods All patients were diagnosed with a tethered cord (TC) due to spinal dysraphism. A high-risk group (HRG) was determined consisting of 40 patients with a lipomyelomeningocele and/or a split cord malformation sometimes in combination with a tight filum terminale. The surgical procedure was a detethering operation in all cases performed by a single surgeon during a 9-year period (1999–2008). A standard set-up of IONM was used in all patients consisting of motor-evoked potentials (MEP) evoked by transcranial electrical stimulation (TES) and electrical nerve root stimulation. In young patients, conditioning stimulation was applied in order to improve absent or weak MEPs. Results IONM responses could be obtained in all patients. Postoperative deterioration of symptoms was found in two patients of whom one patient belonged to the HRG. Mean maximal follow-up of all 65 patients was 4.6 years (median 4.1 years). Long-term deterioration of symptoms was found in 6 of 65 patients with a mean follow-up of 5 years (median 5.3 years). Conclusion The use of IONM is feasible in all TC patients. The identification of functional nervous structures and continuous guarding of the integrity of sacral motor roots by IONM may contribute to the safety of surgical detethering.
- Subjects :
- Male
motor evoked potential
retrospective study
neural tube defect
preschool child
law.invention
transcutaneous electrical nerve stimulation
law
Retrospective analysis
Neural Tube Defects
Tethered Cord
Child
Intraoperative neuromonitoring
Follow up studies
article
General Medicine
Spinal dysraphism
Middle Aged
humanities
Treatment Outcome
priority journal
Child, Preschool
Female
Intraoperative Period
Neurosurgery
intraoperative neurophysiological monitoring
Adult
medicine.medical_specialty
Adolescent
Clinical Neurology
Transcutaneous electrical nerve stimulation
Dethetering
Monitoring, Intraoperative
medicine
intraoperative period
follow up
Humans
Pediatrics, Perinatology, and Child Health
human
Tethered cord
Aged
Retrospective Studies
Original Paper
tethered cord syndrome
business.industry
Electromyography
Infant
Retrospective cohort study
school child
Evoked Potentials, Motor
major clinical study
Electric Stimulation
Surgery
lipomyelomeningocele
Pediatrics, Perinatology and Child Health
Neurology (clinical)
neurophysiology
business
neuromonitoring
Intraoperative neurophysiological monitoring
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 14330350 and 02567040
- Volume :
- 27
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- Child's Nervous System
- Accession number :
- edsair.doi.dedup.....09c57c363af06accf40cc501c7d10877