Turkish Neurosurgery 2010 , Vol 20 , Num 4
Intraoperative Neurophysiological Monitoring During Surgery for Tethered Cord Syndrome
Mehmet BEYAZOVA1, Murat ZINNUROGLU2, Hakan EMMEZ3, Kadir KAYA4, H. Zerrin OZKOSE5, M. Kemali BAYKANER6, Zeynep ERDEN7, Nurdan ORUCOGLU8, Gokhan Tuna OZTURK9, Zeynep ERDOGAN10
1,2,7,8,9,10Gazi University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation Ankara, Turkey
3,6Gazi University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey
4,5Gazi University, Faculty of Medicine, Department of Anesthesiology and Reanimation Ankara, Turkey
DOI : 10.5137/1019-5149.JTN.3314-10.1 Aim: The tethered cord syndrome refers to a variety of lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Permanent or temporary neurological complications were reported following surgical release. In this report, peri- and postoperative results in cases with tethered cord syndrome that were followed by multimodal intraoperative neurophysiological monitoring (MIONM) methods are presented.

Material and Methods: An IONM system (Nicolet CR Endeavor) was used for monitoring during tethered cord surgery. Somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), direct nerve root/rootlet stimulation, free-run electromyography (EMG) and F-waves were used during tethered cord surgery of 10 cases to prevent possible nerve injuries.

Results: MEP and SEP recordings did not change in any of the cases during surgery. The nervous tissue was identified and differentiated from connective tissue in three cases when motor responses were elicited with direct stimulation of nerve roots. None of the cases had neurological deficits following the operation.

Conclusion: Direct nerve root/rootlet stimulation should be one of the components of MIONM during surgery for tethered cord syndrome to prevent postoperative neurological deficits. Keywords : Tethered cord syndrome, Neurophysiological monitoring, Evoked potentials, Spinal cord

Corresponding author : Mehmet Beya Zova, mbeyazova@gmail.com