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Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults.
Surg Neurol. 2004 Aug; 62(2):127-33; discussion 133-5.SN

Abstract

BACKGROUND

Release of tethered spinal cord by sectioning of the filum terminale carries a significant risk of injury to the neighboring motor and sensory nerve roots. Intraoperative neurophysiological monitoring techniques can help to minimize these adverse neurologic outcomes.

METHODS

We performed a retrospective review of 67 consecutive patients undergoing tethered cord release. We excluded 52 pediatric patients which limited our study to 15 adult patients treated during a four year period, including patients with a thick filum, low lying conus, myelomeningocele, filum tumor, spinal cord malformation, and/or lipoma. Clinical outcomes were determined from postoperative follow-up visits. Two patients were lost to follow up and were excluded from the clinical outcome analysis. Electrical stimulation of the filum terminale and lumbo-sacral nerve roots in conjunction with electromyogram (EMG) recording was performed intraoperatively.

RESULTS

The mean electrical threshold for EMG response during stimulation of the filum terminale was 37.1 volts (V), range 15 to 100 V. In comparison, the lowest threshold obtained by direct stimulation of the ventral nerve roots was a mean of 1.46 V, with a range of 0.1 to 7 V. More than 70% of the patients studied demonstrated a filum to motor root threshold ratio of 100:1 or greater. No patient developed new neurologic symptoms or signs postoperatively. Bowel and bladder function improved in 46% of patients, back pain in 39% and motor function in 31%. Eight percent reported decline in bladder control and worsening back pain postoperatively.

CONCLUSIONS

The often dramatic difference in the threshold of the filum terminale and adjacent motor nerve roots (100:1) helps to identify, isolate, and safely section the filum terminale. Tethered cord release using intraoperative neurophysiological monitoring is safe and in the majority of cases leads to improvement or at least, stabilization of neurologic function. Monitoring prevented intraoperative nerve root injury that might have resulted in immediate onset of new neurologic deficits caused by the surgical procedure.

Authors+Show Affiliations

Department of Neurological Surgery, University of California-San Francisco, 505 Parnassus Avenue, Moffitt Hospital Room M779, Box 112, San Francisco, CA 94143-0112, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15261505

Citation

Quiñones-Hinojosa, Alfredo, et al. "Neurophysiological Monitoring for Safe Surgical Tethered Cord Syndrome Release in Adults." Surgical Neurology, vol. 62, no. 2, 2004, pp. 127-33; discussion 133-5.
Quiñones-Hinojosa A, Gadkary CA, Gulati M, et al. Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. Surg Neurol. 2004;62(2):127-33; discussion 133-5.
Quiñones-Hinojosa, A., Gadkary, C. A., Gulati, M., von Koch, C. S., Lyon, R., Weinstein, P. R., & Yingling, C. D. (2004). Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. Surgical Neurology, 62(2), 127-33; discussion 133-5.
Quiñones-Hinojosa A, et al. Neurophysiological Monitoring for Safe Surgical Tethered Cord Syndrome Release in Adults. Surg Neurol. 2004;62(2):127-33; discussion 133-5. PubMed PMID: 15261505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. AU - Quiñones-Hinojosa,Alfredo, AU - Gadkary,Chirag A, AU - Gulati,Mittul, AU - von Koch,Cornelia S, AU - Lyon,Russ, AU - Weinstein,Phillip R, AU - Yingling,Charles D, PY - 2002/05/08/received PY - 2003/11/17/accepted PY - 2004/7/21/pubmed PY - 2004/8/12/medline PY - 2004/7/21/entrez SP - 127-33; discussion 133-5 JF - Surgical neurology JO - Surg Neurol VL - 62 IS - 2 N2 - BACKGROUND: Release of tethered spinal cord by sectioning of the filum terminale carries a significant risk of injury to the neighboring motor and sensory nerve roots. Intraoperative neurophysiological monitoring techniques can help to minimize these adverse neurologic outcomes. METHODS: We performed a retrospective review of 67 consecutive patients undergoing tethered cord release. We excluded 52 pediatric patients which limited our study to 15 adult patients treated during a four year period, including patients with a thick filum, low lying conus, myelomeningocele, filum tumor, spinal cord malformation, and/or lipoma. Clinical outcomes were determined from postoperative follow-up visits. Two patients were lost to follow up and were excluded from the clinical outcome analysis. Electrical stimulation of the filum terminale and lumbo-sacral nerve roots in conjunction with electromyogram (EMG) recording was performed intraoperatively. RESULTS: The mean electrical threshold for EMG response during stimulation of the filum terminale was 37.1 volts (V), range 15 to 100 V. In comparison, the lowest threshold obtained by direct stimulation of the ventral nerve roots was a mean of 1.46 V, with a range of 0.1 to 7 V. More than 70% of the patients studied demonstrated a filum to motor root threshold ratio of 100:1 or greater. No patient developed new neurologic symptoms or signs postoperatively. Bowel and bladder function improved in 46% of patients, back pain in 39% and motor function in 31%. Eight percent reported decline in bladder control and worsening back pain postoperatively. CONCLUSIONS: The often dramatic difference in the threshold of the filum terminale and adjacent motor nerve roots (100:1) helps to identify, isolate, and safely section the filum terminale. Tethered cord release using intraoperative neurophysiological monitoring is safe and in the majority of cases leads to improvement or at least, stabilization of neurologic function. Monitoring prevented intraoperative nerve root injury that might have resulted in immediate onset of new neurologic deficits caused by the surgical procedure. SN - 0090-3019 UR - https://www.unboundmedicine.com/medline/citation/15261505/Neurophysiological_monitoring_for_safe_surgical_tethered_cord_syndrome_release_in_adults_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090301903008413 DB - PRIME DP - Unbound Medicine ER -