Application and significance of neurophysiological monitoring in microsurgery for children with tethered cord syndrome

English Keywords:Tethered Cord Syndrome  Complication  Electrophysiologic monitoring

English Abstract:

  【Abstract】 Objectives: To esplore the application and significance of neurophysiological monitoring in microsurgery for children with tethered cord syndrome(TCS). Methods: A retrospective analysis was made on 49(neurophysiological monitoring group, group A) and 56(no neurophysiological monitoring group, group B) children with tethered cord syndrome between 2008 to 2011 and 2005 to 2007 respectively. All cases with TCS underwent microneurosurgical releasing of tethered cord. Posterior tibial nervesomatosensory evoked potential(PTN-SEP) was detected by Vikingquest Electromyogram Evoked Potential Meter during operation. Spinal dura mater was repaired with a-cyanoacrylate alkyl in strengthening. The complications and outcome between 2 groups were compared. 6 months later, the neurological function and physioelectrical function were evaluated, Hoffman criteria was used for evaluating the outcome. Results: All patients′ surgeries were successful. No case in group A presented paraplegia after operation except 2 cauda equine syndrome and 4 CSF leakage; while in group B, paraplegia, cauda equine syndrome and CSF leakage was noted in 5, 8 and 8 cases respectively, which had higher incidence than group A(P<0.05). 92 patients were followed up for 6 months to 5 years, with an average of 2.5 years. 37 cases in group A had complete release of tethered cord with the release rate of 75%(effective rate, 70%); while 36 cases in group B had complete release with the release rate of 64%(effective rate, 58%), which showed significant difference(P<0.05). Conclusions: Microsurgery with electrophysiologic monitoring has less complications as well as improve release rate and neurofunction for pediatric tethered cord syndrome at short-to-middle stage.