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Multi-modality neurophysiological monitoring during surgery for adult tethered cord syndrome.
J Clin Neurosci. 2005 Nov; 12(8):934-6.JC

Abstract

During complex microneurosurgery performed in patients with tethered cord syndrome, the conus medullaris and the roots that innervate the lower limbs, bladder and bowel are potentially exposed to damage. The aim of multimodality intraoperative monitoring (IOM) is to reduce the risk of inadvertent injury of neural tissue. We simultaneously record tibial nerve somatosensory evoked potentials (SSEPs) from the scalp and free run electromyography (EMG) of limb muscles supplied by L2 to S2 roots, anal and urethral sphincters. We also identify critical neural structures in the operative field, including the conus and exiting nerve roots, with a nerve stimulator to evoke EMG. SSEPs assess the sensory pathways mainly mediated by the S1 roots. Continuous EMG provides the surgeon with immediate auditory feedback resulting from irritative discharges triggered by manipulation of nerve fibres. Microstimulation can distinguish the filum terminale, scar tissue and invasive tumors from functional neural tissue, thus minimizing the risk of iatrogenic injury. Overall multimodality IOM proves a valuable adjunct to microneurosurgery of the lumbosacral spine.

Authors+Show Affiliations

Department of Surgery, University of Toronto; Division of Neurosurgery, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16242934

Citation

Paradiso, Guillermo, et al. "Multi-modality Neurophysiological Monitoring During Surgery for Adult Tethered Cord Syndrome." Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, vol. 12, no. 8, 2005, pp. 934-6.
Paradiso G, Lee GY, Sarjeant R, et al. Multi-modality neurophysiological monitoring during surgery for adult tethered cord syndrome. J Clin Neurosci. 2005;12(8):934-6.
Paradiso, G., Lee, G. Y., Sarjeant, R., & Fehlings, M. G. (2005). Multi-modality neurophysiological monitoring during surgery for adult tethered cord syndrome. Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, 12(8), 934-6.
Paradiso G, et al. Multi-modality Neurophysiological Monitoring During Surgery for Adult Tethered Cord Syndrome. J Clin Neurosci. 2005;12(8):934-6. PubMed PMID: 16242934.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multi-modality neurophysiological monitoring during surgery for adult tethered cord syndrome. AU - Paradiso,Guillermo, AU - Lee,Gabriel Y F, AU - Sarjeant,Roger, AU - Fehlings,Michael G, Y1 - 2005/10/20/ PY - 2004/12/17/received PY - 2005/03/04/accepted PY - 2005/10/26/pubmed PY - 2006/5/11/medline PY - 2005/10/26/entrez SP - 934 EP - 6 JF - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JO - J Clin Neurosci VL - 12 IS - 8 N2 - During complex microneurosurgery performed in patients with tethered cord syndrome, the conus medullaris and the roots that innervate the lower limbs, bladder and bowel are potentially exposed to damage. The aim of multimodality intraoperative monitoring (IOM) is to reduce the risk of inadvertent injury of neural tissue. We simultaneously record tibial nerve somatosensory evoked potentials (SSEPs) from the scalp and free run electromyography (EMG) of limb muscles supplied by L2 to S2 roots, anal and urethral sphincters. We also identify critical neural structures in the operative field, including the conus and exiting nerve roots, with a nerve stimulator to evoke EMG. SSEPs assess the sensory pathways mainly mediated by the S1 roots. Continuous EMG provides the surgeon with immediate auditory feedback resulting from irritative discharges triggered by manipulation of nerve fibres. Microstimulation can distinguish the filum terminale, scar tissue and invasive tumors from functional neural tissue, thus minimizing the risk of iatrogenic injury. Overall multimodality IOM proves a valuable adjunct to microneurosurgery of the lumbosacral spine. SN - 0967-5868 UR - https://www.unboundmedicine.com/medline/citation/16242934/Multi_modality_neurophysiological_monitoring_during_surgery_for_adult_tethered_cord_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0967-5868(05)00221-3 DB - PRIME DP - Unbound Medicine ER -