Surgery for tethered cord syndrome and other cauda equina lesions

Abstract

Publisher Summary This chapter reviews the anatomy, pathology, and clinical features of tethered cord syndrome (TCS). The techniques used for neurophysiologic intraoperative monitoring (NIOM) for surgeries for TCS and caudaequina lesions and their utilities are also discussed. It describes TCS as a disorder that results from the anchoring of the caudal end of the spinal cord to fixed inelastic tissues. This anchoring produces a stretch-induced injury that results in impaired oxidative metabolism in the lower spinal cord. The chapter reviews that whereas TCS is usually present in children, it can occur in adults and usually present with motor, sensory, and sphincter dysfunction involving the lower limbs. Surgery to release the “tethering” of the spinal cord is recommended to prevent further deterioration and possibly reversal of the deficits. It explores that surgery for TCS and other caudaequina lesions involves very careful dissection as often lower lumbar and sacral nerve roots are embedded in the lesion, and can be damaged during the surgery. NIOM is helpful in identifying these neural elements during surgery so that they can be spared.