Cord Damage Research Articles

An emerging role of inflammasomes in spinal cord injury and spinal cord tumor.

Spinal cord injury (SCI) and spinal cord tumor are devastating events causing structural and functional impairment of the spinal cord and resulting in high morbidity and mortality; these lead to a psychological burden and financial pressure on the patient. These spinal cord damages likely disrupt sensory, motor, and autonomic functions. Unfortunately, the optimal treatment of and spinal cord tumors is limited, and the molecular mechanisms underlying these disorders are unclear. The role of the inflammasome in neuroinflammation in diverse diseases is becoming increasingly important. The inflammasome is an intracellular multiprotein complex and participates in the activation of caspase-1 and the secretion of pro-inflammatory cytokines such as interleukin (IL)-1β and IL-18. The inflammasome in the spinal cord is involved in the stimulation of immune-inflammatory responses through the release of pro-inflammatory cytokines, thereby mediating further spinal cord damage. In this review, we highlight the role of inflammasomes in SCI and spinal cord tumors. Targeting inflammasomes is a promising therapeutic strategy for the treatment of SCI and spinal cord tumors.

Integration of multiple prognostic predictors in a porcine spinal cord injury model: A further step closer to reality.

Spinal cord injury (SCI) is a devastating neurological disorder with an enormous impact on individual's life and society. A reliable and reproducible animal model of SCI is crucial to have a deeper understanding of SCI. We have developed a large-animal model of spinal cord compression injury (SCI) with integration of multiple prognostic factors that would have applications in humans. Fourteen human-like sized pigs underwent compression at T8 by implantation of an inflatable balloon catheter. In addition to basic neurophysiological recording of somatosensory and motor evoked potentials, we introduced spine-to-spine evoked spinal cord potentials (SP-EPs) by direct stimulation and measured them just above and below the affected segment. A novel intraspinal pressure monitoring technique was utilized to measure the actual pressure on the cord. The gait and spinal MRI findings were assessed in each animal postoperatively to quantify the severity of injury. We found a strong negative correlation between the intensity of pressure applied to the spinal cord and the functional outcome (P < 0.0001). SP-EPs showed high sensitivity for real time monitoring of intraoperative cord damage. On MRI, the ratio of the high-intensity area to the cross-sectional of the cord was a good predictor of recovery (P < 0.0001). Our balloon compression SCI model is reliable, predictable, and easy to implement. By integrating SP-EPs, cord pressure, and findings on MRI, we can build a real-time warning and prediction system for early detection of impending or iatrogenic SCI and improve outcomes.

Paroxysmal painful tonic spasms in neuromyelitis optica spectrum disorder

Recently, an association between painful tonic spasms (PTS) and Neuromyelitis Optica Spectrum Disorder (NMOSD) was established. To describe the clinical characteristics of PTS in NMOSD based on a video recording and to provide a literature review on the topic. We report a case of a 38years-old woman with a diagnosis of NMOSD and positive aquaporin-4 IgG antibody status who developed PTS five weeks after an episode of longitudinal extensive transverse myelitis (LETM). Repetitive, brief, and painful episodes of muscle contraction were observed on the patient's left hand, spreading to the left arm, and then extending to the four limbs. While pregabalin and topiramate had no influence on these episodes, the patient responded to carbamazepine (CBZ), without symptom recurrence after one year. PTS in association with LETM can be considered typical for NMOSD. Although the exact mechanism is unknown, ephaptic transmission after spinal cord damage and excitatory soluble factors released during acute inflammation responses are sought to be involved. Symptomatic treatment with CBZ achieved remission of spams in our case.

Bioinformatics-based diagnosis and evaluation of several pivotal genes and pathways associated with immune infiltration at different time points in spinal cord injury

ABSTRACT Spinal Cord Injury (SCI) is a devastating neurological event. To assess the degree of spinal cord damage and classify the injury, it is recommended to use the 2019 version of the AIS standard. The severity of trauma was evaluated using the Trauma Severity Score, and various classification systems have been proposed for injuries at different parts and segments of the spine. Understanding the regulated signaling pathways and immune processes following SCI can lead to a better understanding of SCI-induced biomarkers and their underlying mechanisms. In this study, two gene expression datasets (GSE464 and GSE45006) from the Gene Expression Omnibus database were utilized. Differential gene expression and co-expression network analysis were performed, revealing 370 shared genes in the 3-day group and 111 shared genes in the 14-day group after SCI. The study used functional enrichment analysis methods such as Gene Set Enrichment Analysis, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes. The ssGSEA method was used to assess the levels and composition of immune infiltration in both the sham (control) and SCI groups. The single-cell transcriptomics dataset GSE182803 was analyzed to identify genes associated with immune marker cells. Four key genes (Ptgs2, Fn1, Ccl2, and Icam1) were identified in the 3-day group, while only one gene (Cyp51) was identified in the 14-day group after SCI. The findings offer significant insights into the immune-related genes and signaling pathways involved in secondary SCI at different time points and hold potential for the development of intervention strategies for acute and chronic post-SCI.

The Role of Magnetic Transcranial Stimulation in the Diagnosis and Post-Surgical Follow-Up of Cervical Spondylotic Myelopathy.

Degenerative cervical myelopathy (DCM) consists of spinal cord damage due to its compression through the cervical spine. The leading cause is degenerative. The diagnosis is clinical, and the therapeutic approach is usually surgical. Confirmation of the diagnostic suspicion is done by magnetic resonance imaging (MRI); however, this test lacks functional information of the spinal cord, the abnormality of which may precede involvement in neuroimaging. Neurophysiological examination using somatosensory evoked potentials (SSEPs) and transcranial magnetic stimulation (TMS) allows for an evaluation of spinal cord function, and provides information in the diagnostic process. Its role in the post-surgical follow-up of patients undergoing decompressive surgery is being studied. We present a retrospective study of 24 patients with DCM and surgical decompression who underwent neurophysiological tests (TMS and SSEP) before, 6, and 12 months after surgery. The result of the TMS and the SSEP in the post-operative follow-up did not correlate with the clinical outcome, either subjective or measured by clinical scales at six months. We only found post-surgical improvement of central conduction times (CMCTs) in patients with severe pre-surgical motor impairment on TMS. In patients with normal pre-surgical CMCT, we found a transient worsening with return to baseline at the one-year follow-up. Most patients presented pre-surgical increased P40 latency at diagnosis. CMCT and SSEP were more related to clinical outcomes one year after the surgical procedure and were very useful in diagnosing.

Beyond Pattern Recognition: Radiology-Pathology-Clinical Correlation.

Radiology-pathology correlation is essential for multidisciplinary collaboration in diagnosis and understanding the mechanism of CNS damage in infectious processes. The microscopic acute inflammatory processes are well established and are supplemented by a variety of less-invasive microbial and immunohistochemical investigations. Understanding the pathogenesis of pathogen spread and neuroinvasion, vascular and immune-mediated brain, and spinal cord damage are essential for interpreting radiological images.

Mouse Model of Spinal Cord Hypoperfusion with Immediate Paralysis Caused by Endovascular Repair of Thoracic Aortic Aneurysm.

A clinically relevant mouse model of thoracic endovascular aortic repair-induced ischemic spinal cord injury has been lacking since the procedure was first employed in 1991. The hypothesis was that ligation of mouse intercostal arteries would simulate thoracic endovascular aortic repair-induced ischemic spinal cord injury and behavioral deficit. The aim was to create a mouse model of thoracic endovascular aortic repair-induced spinal cord hypoperfusion by ligating five pairs of mouse intercostal vessels. Mice were divided into sham (n = 53) and ligation (n = 60) groups. The procedures called for double ligation of three pairs and single ligation of two pairs of thoracic intercostal arteries in adult C57BL/6 mice. A laser Doppler probe was used in vivo on the spinal cords and intercostal arteries to document the extent of arterial ligation and spinal cord hypoperfusion. The Basso Mouse Scale for Locomotion, histological studies, and electron microscopy demonstrated postligation locomotive and histopathological changes. Ligation induced a significant and instantaneous drop in blood flow in the intercostal arteries (% change; mean = -63.81; 95% CI, -72.28 to -55.34) and the thoracic spinal cord (% change; mean = -68.55; 95% CI, -80.23 to -56.87). Paralysis onset was immediate and of varying degree, with behavioral deficit stratified into three groups: 9.4% exhibited severe paralysis, 37.5% moderate paralysis, and 53.1% mild paralysis at day 1 (n = 32; P < 0.001). Mild and moderate paralysis was transient, gradually improving over time. Severe paralysis showed no improvement and exhibited a higher mortality rate (83%; n = 15 of 18) compared to moderately (33%; n = 6 of 18) and mildly (24%; n = 6 of 25) paralyzed mice (P < 0.001). The overall ligation group survival rate (84%; n = 46 of 55) was significantly lower than the sham group (100%; n = 48 of 48) with P = 0.003. The mouse model generates reproducible spinal cord hypoperfusion and accompanying histopathological ischemic spinal cord damage. The resulting anatomical changes and variable behavioral deficits mimic the variability in radiological and clinical findings in human patients.

Valproic Acid Attenuates Oxidative Damage in Rat Spleen Tissue Induced By Spinal Cord Damage

Events such as oxidative stress caused by spinal cord injury (SCI) are a serious condition because they negatively affect many organs. Alternative treatment options for this type of injury are quite limited. In this study, we planned to investigate the effect of oxidative damage on the spleen tissue of rats with spinal cord damage and the protective role of valproic acid (VPA) in this damage. Sixteen Wistar albino rats were divided into two equal groups. No treatment was administered to the rats in Group 1 (SCI-(Control), but a single dose of 300 mg/kg intraperitoneally VPA was administered to the rats in Group 2 (SCI-VPA). Superoxide dismutase (SOD) activities, total antioxidant status (TAS) and total oxidant status (TOS) levels were examined as markers of oxidative stress in spleen tissues taken after decapitation of rats. VPA treatment increased the SOD and TAS level but decreased the TOS level, indicating improved oxidative damage and impaired enzymatic antioxidant levels in spleen tissue homogenate damaged by SCI. We have observed that VPA, which has many beneficial properties, has a significant healing effect on spleen tissue affected by SCI-induced oxidative stress.

Could spinal cord oscillation contribute to spinal cord injury in degenerative cervical myelopathy?

IntroductionDegenerative Cervical Myelopathy [DCM] is a slow-motion spinal cord injury. Compression and dynamic compression have been considered disease hallmarks. However, this is likely an oversimplification, as compression is more commonly incidental and has only modest correlation to disease severity. MRI studies have recently suggested spinal cord oscillation could play a role. Research questionTo determine if spinal cord oscillation could contribute to spinal cord injury in degenerative cervical myelopathy. Material and methodsA computational model of an oscillating spinal cord was developed from imaging of a healthy volunteer. Using finite element analysis, the observed implications of stress and strain, were measured in the context of a simulated disc herniation. The significance was bench marked by comparison to a more recognised dynamic injury mechanism; a flexion extension model of dynamic compression. ResultsSpinal cord oscillation altered both compressive and shear strain on the spinal cord. Following initial compression, compressive strain moves from within the spinal cord to the spinal cord surface, whilst shear strain is magnified by 0.1–0.2, depending on the amplitude of oscillation. These orders of magnitude are equivalent to a dynamic compression model. Discussion and conclusionSpinal cord oscillation could significantly contribute to spinal cord damage across DCM. Its repeated occurrence with every heartbeat, draws parallels to the concept of fatigue damage, which could reconcile differing theories on the origins of DCM. This remains hypothetical at this stage, and further investigations are required.

Retracted: Design of LoRa Antenna for Wearable Medical Applications

The intraoral Tongue Drive System (iTDS) is a wireless assistive technology (AT) that may be operated using a variety of user-defined voluntary tongue motions. In this study, we introduce a novel arch-shaped iTDS that takes up the buccal shelf space in the mouth without constricting tongue motions. Damage to the central nervous system that causes upper limb paralysis. For instance, severe spinal cord injuries, certain strokes or multiple amputations of the upper limbs can make it very difficult for a lot of individuals to go about their everyday lives since they cause them to lose function, control, and independence. Because its muscles are strong and dexterous and do not quickly tire when not necessary to exert power, the tongue is an excellent choice for controlling an AT. Additionally, through cranial nerves, which are unaffected by a spinal cord damage, the tongue is directly attached to the brain. Furthermore, since the tongue movements may be totally hidden from view, TDS-based AT safeguard users’ privacy. In order to provide an effective solution, this paper proposed a novel antenna design with dual-band and implantability. The antenna is modelled in single-layer human muscle considering the feasibility and computational time. Then, the performance is evaluated through multi-layered human oral cavity model. A protective layer is established to prevent direct contact between the antenna and human body. Simulation results show that the proposed antenna has better reflection coefficient, impedance, and radiation pattern as compared with existing antennas.

Das soziale Gehirn – 2. Bedeutung von erworbenen Hirnschädigungen für das Sozialverhalten: Klinik, Diagnostik und Therapie

Nach erworbenen Hirnschädigungen führen Störungen der sozialen Kognition und der sozialen Kompetenz häufig zu erheblichen Einschränkungen in der sozialen Teilhabe, zu sozialem Rückzug und Isolation. Infolge erhöhter Morbidität und Mortalität sind diese Störungen auch sozialmedizinisch relevant. Allerdings besteht ein Mangel sowohl an Diagnostik als auch an Angeboten therapeutischer oder rehabilitativer Interventionen. Die vorliegende Literaturübersicht plädiert nach einem Überblick über die Studienlage für eine systematischeren Erfassung von Störungen der sozialen Kognition und Kompetenz nach erworbener Hirnschädigung sowie für die Entwicklung und Überprüfung weiterer therapeutische Interventionen zu ihrer Behandlung. Schlüsselwörter: soziale Kognition, soziale Kompetenz, erworbene Hirnschädigung, Schädel-Hirn-Trauma, Schlaganfall, Teilhabe, Rehabilitation

Histopathological and immunohistochemical investigation of the effect of Shilajit in rats with experimental spinal cord injury.

This experimental study was designed to investigate the histopathological and immunohistochemical effects of Shilajit in rats with experimentally induced spinal cord injury (SCI). The rats were divided into three groups: Control group: The group in which spinal cord damage was created but no drug was administered. Low-dose group: This is the group in which intraperitoneal Shilajit is given at a dose of 150 mg/kg at the 1st h, 1st day, 2nd day, and 3rd day after spinal cord damage was induced. High-dose group: This is the group in which intraperitoneal Shilajit is given at a dose of 250 mg/kg at the 1st h, 1st day, 2nd day, and 3rd day after spinal cord damage was induced. Thin sections taken from the spinal cord after euthanasia were sent for histopathological and immunohistochemical examination. Histopathological examination of the high-dose group showed lower amounts of morphological findings compared to the low-dose group and control group. While a significant CD68 immune reaction was observed in the control group of rats with spinal injury, the positive immune reaction was found to be significantly decreased in the Shilajit-applied groups. It is thought that the use of Shilajit in SCI will reduce the effects of secondary damage in SCI and that its administra-tion to such patients will have positive effects on the results.

Application of a Modified Dorsal Wiring Method in Toy Breed Dogs With Atlantoaxial Subluxation.

Atlantoaxial subluxation (AAS) is a congenital or traumatic condition that often requires surgical stabilization. Surgery is performed via a ventral or dorsal approach. A ventral approach is challenging in toy breed dogs due to their small-sized bones. Reducing AAS by orthopedic wire via a dorsal approach can cause iatrogenic spinal cord damage. Due to these limitations, a Kishigami atlantoaxial tension band (Kishigami AATB) that remains in the epidural space has been devised. Similar to the Kishigami AATB, the present study developed a modified dorsal wiring method and evaluated it in toy breed dogs with AAS. Medical data of toy breed dogs with AAS that underwent surgical stabilization using the modified dorsal wiring method from 2017 to 2020 were retrospectively reviewed. A total of 10 dogs were analyzed. Regarding the history of these dogs, six dogs had congenital AAS, and the remaining four dogs had traumatic AAS. Evaluation via computed tomography was available for five dogs, of which two dogs were identified as having incomplete ossification of their atlas. Although four dogs required a revision surgery because of recurrence of clinical signs or fracture of the atlas, final functional improvement was achieved in nine dogs. One dog showed worsened neurological status that led to death. Clinical results with the modified dorsal wiring method were similar to those with the Kishigami AATB. The modified dorsal wiring method is versatile as it could be applied to various shapes of dogs' atlas. Considering the shape of the atlas, it is recommended to apply the implant as far from the midline of the dorsal arch as possible to avoid fractures. With selection of suitable patients, this modified dorsal wiring method can be applied to dorsal stabilization of AAS in toy breed dogs.

Effect of Sacral Nerve Stimulation on Detrusor Overactivity among Spinal Cord Injury

comAbstractBackground and aim:Spinal cord injury is still a leading cause of disability. Nowadays, there is a high level of illness and death. According to the National Spinal Cord Injury Statistical Centre, every year, 40 new instances per million people are documented. Over 80% of these people have some form of bladder dysfunction. Some studies suggest that sacral nerve stimulation can help with bladder dysfunction. Hence, this study was aimed to identifythe benefit of sacral neuronal activity on detrusor over activity among spinal cord injury. Material &amp; methods:This pilot testwas analysedat the Saveetha Institute of Medical Science and Technology (SIMATS). For a four-week period, 15 patients with post-spinal cord injury were chosen. Patients were evaluated with overactive bladder symptoms score before the initiation of treatment. The patients were given with sacral nerve stimulation for 4 weeks 2 sessions per day. After 4 weeks of intervention patients were assessed with overactive bladder symptoms score as a posttest value. Result:The statistical analysis revealed a statistically significant improvement. The sacral nerve stimulation has been demonstrated to be efficacious in curing detrusor overactivity caused by spinal cord damage. Conclusion:This study emphasizes that sacral nerve stimulation improves bladder function in people with spinal cord injuries.

Neuromodulation and quality of life for patient with spasticity after spinal cord injury.

Spasticity develops in 80% of spinal cord injury cases and negatively affects the patents' quality of life. The most common method of surgical treatment for severe spasticity is a long-term intrathecal baclofen therapy (ITB). Long-term spinal cord stimulation is another possible treatment technique. This paper aims to evaluate the changes in quality of life for patients with spasticity who have been treated with neuromodulation (SCS or ITB) in 12 months after the surgery, as well to compare the changes in quality of life for patients who have been treated with spinal cord stimulation and those who received long-term intrathecal baclofen therapy. The influence of spasticity, experienced by the patients with a spinal cord injury, on their quality of life was analyzed before the surgery and 12 months after it. The severity of the spinal cord damage was determined with the scale of the American Spinal Injury Association (ASIA); spasticity was evaluated with the modified Ashworth scale, Penn Spasm Frequency Scale; pain levels were determined with visual analogue scale (VAS), anxiety and depression levels - with HADS. Functional activity of the patients was evaluated with the help of the Functional Independence Measure (FIM). The treatment results for 33 patients (25 men and 8 women), aged from 18 to 62, are presented. After the trial stimulation, the patients were randomly assigned to either SCS or ITB group (18 and 15 people respectively). The decrease of spasticity in both experimental groups caused lower levels of pain, less functional dependency on other people, lower stress and depression rates and, as a consequence, better quality of life and social adaptation. The obtained results for SCS and ITB groups are statistically similar.

Conducting spinal cord injury model with clip compression in rodents: Pearls and pitfalls

Research on spinal cord injuries is an important and living topic that raises many critical questions that need to be addressed. While numerous articles have compiled and compared various models of spinal cord injuries, there is limited comprehensive guide with clear instructions available for researchers who are unfamiliar with clip compression model. This model creates acute compression damage in spinal cord, which aims to mimic the nature of traumatic spinal cord damage in humans. Purpose of this article is to share our experience on clip compression model, with experience gained from more than 150 animals, and to provide guidance for researchers with lack of experience who wish to design studies with this model. We have defined several key variables, as well as the difficulties that may arise when applying this model.−Proper preparation, good infrastructure and necessary tools and knowledge of anatomy related is essential to the success of this model.−Good exposure with non-bleeding surgical site is key factor for surgical step.−Postoperative care is particularly challenging, and researchers should consider extending their studies over a reasonable time period to ensure that appropriate care could be provided.

Chapter 5 - Transverse myelitis in children and adults

Transverse myelitis is a noncompressive myelopathy of inflammatory origin. The causes are broad, ranging from infective or toxic to immuno-mediated etiology. They can be manifestations of systemic diseases, such as sarcoidosis and systemic lupus erythematous, or phenotypes of neuroinflammation; in a portion of cases, the etiology remains unknown, leading to the designation idiopathic. The clinical presentation of transverse myelitis depends on the level of spinal cord damage and may include sensorimotor deficits and autonomic dysfunction. The age of onset of the disorder can impact the symptoms and outcomes of affected patients, with differences in manifestation and prognosis between children and adults. Spinal cord magnetic resonance imaging and cerebrospinal fluid examination are the main diagnostic tools that can guide clinicians in the diagnostic process, even though the search for antibodies that target the structural components of the neural tissue (anti-aquaporin4 antibodies and anti-myelin-oligodendrocyte antibodies) helps in the distinction among the immune-mediated phenotypes. Management and outcomes depend on the underlying cause, with different probabilities of relapse according to the phenotypes. Hence, immunosuppression is often recommended for the immune-mediated diseases that may have a higher risk of recurrence. Age at onset has implications for the choice of treatment.

Penetrating Neck Injury due to Foreign Body at C5 Level with Plexus Brachialis Nerve Injury: A Case Report

Abstract: Penetrating neck injury caused by screwdriver is a very rare case. Rapid transport to a major trauma center is needed for such patients to prevent neurological dysfunction and post traumatic tissue damage. Early and complete assessment and exact surgical procedure are very important to overcome a good outcome and prognosis. We reported a case of a 28-year-old male transferred to the emergency room after being stabbed using a screwdriver. No history of nausea, vomiting, and loss of consciousness. A screwdriver got stucked on the neck at the level of C5-C6 associated with edema but no active bleeding. The upper extremity examination revealed that the muscle contraction was 5555/4444, thumb test +/, opposition test +/-, abductor adductor test +/-, and sensory within normal limit. Radiology examination showed a metallic density of the foreign body in the cervical region penetrating from soft tissue to the vertebral body of cervical C5. The patient was diagnosed with penetrating neck injury due to foreign body in the posterior neck region at C5 level with plexus brachialis nerve injury. Foreign body removal and laminectomy were done to decompression purpose. This case need early, complete and adequate management to prevent post traumatic tissue damage, other neurological dysfunction, and mortality. On the fourth post-surgical day, the patient was discharged with stable vital signs and no neurological deficit. The regular follow up at the neurosurgical clinic showed that neither motoric nor sensoric deficit was found. In conclusion, penetrating neck injury which can cause severe morbidity and permanent disability need an adequate management to prevent any spinal cord damage and minimize any neurological dysfunction. Keywords: penetrating neck injury; spinal cord injury

Neurophysiologic evaluation of patients with cervical spondylotic myelopathy

BackgroundCervical spondylotic myelopathy (CSM) is a neurodegenerative disease caused by repetitive spinal cord damage that has resulted in significant clinical morbidity. The clinical evaluation of signs and symptoms, as well as neuroimaging and several neurophysiological tests, are used to make the diagnosis.ObjectivesTo investigate changes in the cutaneous silent period (CuSP), cortical silent period (CoSP), and H-reflex in CSM patients, and to correlate these tests with the Japanese Orthopedic Association (JOA) score and Nurick’s grading, as well as to determine the diagnostic value of each of them.MethodsTwenty patients (14 males and 6 females) with CSM were clinically diagnosed and documented by magnetic resonance imaging (MRI), and they were paired with another 20 healthy volunteers (13 males and 7 females) as a control group. CuSP, CoSP, and H-reflex tests were performed on both groups.ResultsIn CSM patients, CuSP latency and duration are substantially longer and shorter in CSM patients, respectively. The degree of changes in CuSP latency is well correlated with the severity of the disease. Further, CoSP duration is significantly shortened. The H-reflex parameters did not differ significantly between the patient and control groups.ConclusionThe shortened CoSP’s duration and the prolonged CuSP's latency suggest malfunction of the inhibitory and excitatory circuits in the spinal cord. The CuSP is more sensitive and specific than the CoSP in the diagnosis of a patient with CSM.

Surgical treatment of tethered cord syndrome with sacral canal cysts: Analysis of 13 cases

TCS is a clinical manifestation of abnormal stretch of spinal cord, which needs to be solved urgently. To review and summarize the most recent surgical cases in our department involving a rare disease (tethered cord syndrome (TCS) with sacral canal cyst). From December 2015 to February 2018, thirteen patients with TCS and a sacral canal cyst, ranging in age from 8 to 53 years, were enrolled. There were eight males and five females in the group. A spine X-ray, CT, MR, lower extremity evoked potential, residual urine, and urodynamics were performed in addition to the standard preoperative examination. All patients underwent microsurgery while being electrophysiologically monitored. During the operation, Kirollos and Van-Hille graded the degree of tethered cord release, as well as Hoffman's neurological functional grading to assess efficacy and lumbosacral MRI observation of the sacral canal cyst recurrence. There were no deaths. The TCS was completely released during the operation, and the sacral canal cyst did not recur. Except for one patient who experienced increased postoperative symptoms, the symptoms or signs of the remaining patients improved to varying degrees, according to the Hoffman neurological function classification. In sacral canal cyst patients, intraoperative use of a surgical microscope and electrophysiological nerve function monitoring can effectively reduce spinal cord and nerve damage and improve surgical safety.