[Intraoperative neurophysiological monitoring in children undergoing tethered cord surgery]

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Medical Monitoring

Background:

• Tethered cord syndrome (TCS) is a congenital condition requiring surgical intervention.
• Untethering cord procedures aim to release the spinal cord from abnormal attachments.
• Intraoperative monitoring (IOM) is crucial for preserving neurological function during spinal surgery.

Purpose of the Study:

• To evaluate the efficacy of a multimodal intraoperative monitoring (IOM) technique.
• To assess IOM during untethering cord procedures in pediatric patients with TCS.
• To determine the safety and effectiveness of IOM in this specific surgical context.

Main Methods:

• Retrospective analysis of 37 pediatric patients (1 month-16 years) with TCS.
• Utilized nerve mapping, electromyogram (EMG), and transcranial motor-evoked potentials (tcMEP).
• Monitored extremity muscles and anal sphincters for functional integrity.

Main Results:

• Achieved 100% success in nerve mapping.
• Extremity muscle tcMEP monitorability was 86.5% (32/37 patients).
• tcMEP remained stable intraoperatively; no significant transient neurological worsening observed postoperatively.

Conclusions:

• Multimodal IOM enhances procedural safety in untethering cord surgery.
• This technique helps minimize long-term morbidity associated with TCS.
• IOM contributes to improved clinical outcomes for pediatric patients with TCS.