The clinical application of intraoperative neurophysiological monitoring in surgery of spinal cord untethering in children

Abstract

Objective To explore the application value of intraoperative neurophysiological monitoring in the surgery of spinal cord untethering. Methods A total of 35 patients with tethered cord syndrome admitted to Department of Neurosurgery, Yuquan Hospital, Tsinghua University from June 2014 to December 2016 were electrophysiologically monitored in terms of somatosensory evoked potentials (SEP) and electromyogram(EMG) during operation. The Hoffman scale was adopted to evaluate nerve function in all patients. The changes of electrophysiological parameters and the nerve functions were analyzed. The relationship between SEP monitoring results and Hoffman scale was investigated. Results Among 35 patients, the cortical potential P40 was recorded in 29 cases. There were continuous bursts of large myoelectric response in 21 patients during operation. All patients underwent nerve root stimulation to identify the cauda equina and filum terminale, the latter were then cut. The follow-up period lasted 6-13 months with an average of 9.4±5.8 months. Significant improvement of neurological function was reported in 8 patients, fair improvement in 18, and no improvement in 9 cases. Comparative analysis showed that in the patients with significant improvement, postoperative amplitude and latency were significant different from preoperative results (both P 0.05). Conclusion Employed in the surgery of spinal cord untethering in children, intraoperative electrophysiological monitoring could effectively help avoid nerve damage, reduce the occurrence of postoperative complications, and improve the clinical outcomes. Key words: Tethered cord syndrome; Neurosurgical procedures; Monitoring, intraoperative; Electrophysiology; Child