Updates on Intraoperative Neurophysiology During Surgery for Spinal Dysraphism

Area of Science:

• Neuroscience
• Developmental Biology
• Neurosurgery

Background:

• Spinal dysraphism encompasses disorders from embryologic failures in spinal cord development.
• This can result in mechanical stretch, vascular compromise, and hypoxic-ischemic damage to the conus-cauda region.
• Clinical relevance stems from potential neurological deficits due to spinal cord tethering.

Purpose of the Study:

• To discuss the clinical relevance of spinal dysraphism.
• To explore the indications and timing of detethering surgery.
• To highlight the role of intraoperative neurophysiology in tethered cord surgery.

Main Methods:

• Literature review on spinal dysraphism and tethered cord surgery.
• Analysis of clinical presentations and surgical outcomes.
• Evaluation of the impact of intraoperative neurophysiology.

Main Results:

• Clinical presentation of spinal dysraphism is heterogeneous, ranging from asymptomatic to severe deficits.
• Debate exists regarding optimal indications and timing for detethering surgery.
• Intraoperative neurophysiology is crucial for reducing iatrogenic neurological damage during surgery.

Conclusions:

• Spinal cord tethering in spinal dysraphism can cause significant neurological deficits.
• While surgical timing is debated, high treatment standards are agreed upon.
• Intraoperative neurophysiology is vital for ensuring the safety of detethering procedures.