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Clinical outcome in children undergoing tethered cord release utilizing intraoperative neurophysiological monitoring.
Pediatr Neurosurg. 2002 Aug; 37(2):81-6.PN

Abstract

Release of tethered spinal cord by sectioning of the filum terminale carries a risk of injuring neighboring motor and sensory nerve roots involved in bowel and bladder control. Therefore, intraoperative neurophysiological monitoring techniques have been developed to prevent neurological complications postoperatively. We performed a retrospective chart review of 63 patients who had undergone tethered cord release. We excluded adult patients, those lost to follow-up and patients with either a myelomeningocele and/or lipoma. This limited our study to 25 pediatric patients, aged 4 months to 12 years, who underwent tethered cord release for either a thickened filum terminale and/or a low-lying conus. For intraoperative monitoring, we utilized electrical stimulation of the filum terminale, lumbosacral nerve roots and electromyography recordings. Ventral nerve roots were identified and their electrical thresholds obtained. The mean was 0.32 V, the mode 0.1 V and the range 0.05-1.0 V. These values were compared to electrical thresholds obtained by stimulation of the filum terminale. The mean was 26.1 V, the mode 20.0 V and the range 8-100 V. In over 70% of patients, muscle activation via the filum required 100 times the voltage needed to activate a motor root. This motor root to filum threshold of 1:100 was useful in identifying the filum. Clinical outcome showed no significant worsening with respect to bowel and bladder control or pain and motor indices. Significant bowel and bladder improvement was seen in 4 out of 25 patients, motor improvement in 9 out of 25 patients and improvement of pain in 4 out of 25 patients. Three patients developed postoperative urinary tract infections, but no cerebrospinal fluid leaks or pseudomeningoceles were encountered. These results suggest that patients with a thickened filum or low-lying conus can safely undergo tethered cord release. Intraoperative neurophysiological monitoring provides a helpful adjunct to distinguish nerve roots from the filum. A ratio, rather than an absolute number, is beneficial in distinguishing motor roots from the filum and eliminates variability due to patients' individual differences in electrical thresholds.

Authors+Show Affiliations

Department of Neurological Surgery, Room M-779, Box 0112, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA. cvonkoch@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12145516

Citation

von Koch, Cornelia S., et al. "Clinical Outcome in Children Undergoing Tethered Cord Release Utilizing Intraoperative Neurophysiological Monitoring." Pediatric Neurosurgery, vol. 37, no. 2, 2002, pp. 81-6.
von Koch CS, Quinones-Hinojosa A, Gulati M, et al. Clinical outcome in children undergoing tethered cord release utilizing intraoperative neurophysiological monitoring. Pediatr Neurosurg. 2002;37(2):81-6.
von Koch, C. S., Quinones-Hinojosa, A., Gulati, M., Lyon, R., Peacock, W. J., & Yingling, C. D. (2002). Clinical outcome in children undergoing tethered cord release utilizing intraoperative neurophysiological monitoring. Pediatric Neurosurgery, 37(2), 81-6.
von Koch CS, et al. Clinical Outcome in Children Undergoing Tethered Cord Release Utilizing Intraoperative Neurophysiological Monitoring. Pediatr Neurosurg. 2002;37(2):81-6. PubMed PMID: 12145516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcome in children undergoing tethered cord release utilizing intraoperative neurophysiological monitoring. AU - von Koch,Cornelia S, AU - Quinones-Hinojosa,Alfredo, AU - Gulati,Mittul, AU - Lyon,Russ, AU - Peacock,Warwick J, AU - Yingling,Charles D, PY - 2002/7/30/pubmed PY - 2002/10/17/medline PY - 2002/7/30/entrez SP - 81 EP - 6 JF - Pediatric neurosurgery JO - Pediatr Neurosurg VL - 37 IS - 2 N2 - Release of tethered spinal cord by sectioning of the filum terminale carries a risk of injuring neighboring motor and sensory nerve roots involved in bowel and bladder control. Therefore, intraoperative neurophysiological monitoring techniques have been developed to prevent neurological complications postoperatively. We performed a retrospective chart review of 63 patients who had undergone tethered cord release. We excluded adult patients, those lost to follow-up and patients with either a myelomeningocele and/or lipoma. This limited our study to 25 pediatric patients, aged 4 months to 12 years, who underwent tethered cord release for either a thickened filum terminale and/or a low-lying conus. For intraoperative monitoring, we utilized electrical stimulation of the filum terminale, lumbosacral nerve roots and electromyography recordings. Ventral nerve roots were identified and their electrical thresholds obtained. The mean was 0.32 V, the mode 0.1 V and the range 0.05-1.0 V. These values were compared to electrical thresholds obtained by stimulation of the filum terminale. The mean was 26.1 V, the mode 20.0 V and the range 8-100 V. In over 70% of patients, muscle activation via the filum required 100 times the voltage needed to activate a motor root. This motor root to filum threshold of 1:100 was useful in identifying the filum. Clinical outcome showed no significant worsening with respect to bowel and bladder control or pain and motor indices. Significant bowel and bladder improvement was seen in 4 out of 25 patients, motor improvement in 9 out of 25 patients and improvement of pain in 4 out of 25 patients. Three patients developed postoperative urinary tract infections, but no cerebrospinal fluid leaks or pseudomeningoceles were encountered. These results suggest that patients with a thickened filum or low-lying conus can safely undergo tethered cord release. Intraoperative neurophysiological monitoring provides a helpful adjunct to distinguish nerve roots from the filum. A ratio, rather than an absolute number, is beneficial in distinguishing motor roots from the filum and eliminates variability due to patients' individual differences in electrical thresholds. SN - 1016-2291 UR - https://www.unboundmedicine.com/medline/citation/12145516/Clinical_outcome_in_children_undergoing_tethered_cord_release_utilizing_intraoperative_neurophysiological_monitoring_ L2 - https://www.karger.com?DOI=10.1159/000065109 DB - PRIME DP - Unbound Medicine ER -