Francis, Jacintha Vikeneswary
(2015)
Electrophysiology versus clinical outcomes of tethered cord surgery assisted with intraoperative mep and ssep in Hospital Queen Elizabeth Kota Kinabalu Sabah : a prosperctive cohort pilot study.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction:
The tethered cord syndrome (TCS) is an uncommon disease caused by an
abnormal stretching of the spinal cord, reported incidence of 0.05 to 0.25 per births
untethering of the tight filum terminale. Spinal dysraphism is associated with tethered
cord, which includes malformations like myelomeningocele, lipomyelomeningocele,
tight filum terminale, split cord malformation, and dermoid sinus. Once the symptoms
have developed, the patient has a terthered cord syndrome (TCS). These symptoms
may either be neurological, urological, orthopedic, or pain.
The goal of surgery is to detether the cord by disconnecting its aberrant tightening
attachments, and to relieve the cord from continuous stretching forces. Tethering
structures may consist lipoma, fibrous bands, non-functional nervous tissue, or a
dermoid sinus tract. Peroperatively it can be difficult to distinguish between
functional neural tissue and these non-functional tethering structures. Permanent
neurological complications were reported in about 4.5% of patients, and this was high
as 10.9% when transient complications were taken into account. Intraoperative
neurophysiological monitoring (IONM) may help to protect the functional nervous
tissue and prevent postoperative neurological deficits. There is no evident consensus
on the exact methods of multimodal (M) IONM that should be used during surgery
for TCS.
The use of intraoperative neurophysiological monitoring (IONM) may contribute to
the safety in tethered cord surgery. We present a series of 15 patients with a wide
variety of morphology of spinal dysraphism. All patients were operated for reasons of
a tethered cord with the preoperative use of IONM. The usage of IONM in the
different age groups and its potential contribution to the safety of the procedure are
investigated.
This will further aid in prognosticating the neurological outcome of patients
undergoing TC surgery.
This study also helps us in evaluating the importance of IONM in tethered cord
surgery.
Conclusion:
NIOM during TCS surgery can be used not only to aid with safety of surgery but in
prognosticating on the postoperative outcome of the patient. This will eventually help
in reducing operative morbidity , thus giving a likely favourable outcome.
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