Application of neurophysiological monitoring during tethered cord release in children
Junjun Guo1, Xianlan Zheng2, Hongyao Leng3
1Department of Neurosurgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, 400000, China.
Insights
Intraoperative neurophysiological monitoring (IONM) did not improve short-term outcomes for pediatric tethered spinal cord release. However, IONM showed better medium- to long-term prognoses, indicating its value in improving patient outcomes over time.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Monitoring
- Neurological Dysfunction
Background:
- Tethered spinal cord syndrome (TSCS) affects children, requiring surgical release.
- Intraoperative neurophysiological monitoring (IONM) is a technique used during spinal surgeries.
- The impact of IONM on TSCS release outcomes requires further investigation.
Purpose of the Study:
- To evaluate the effect of IONM on the outcomes of surgical tethered spinal cord release in pediatric patients.
- To compare short-term and long-term results between patients who underwent IONM and those who did not.
Main Methods:
- Retrospective analysis of 454 children with TSCS undergoing tethered cord release.
- Comparison of two groups: non-IONM and IONM.
- Statistical analysis using SPSS 26.0, evaluating effective rate and incidence of new neurological dysfunction.
Main Results:
- No significant difference in short-term effective rates or new neurological dysfunction between groups.
- Significant improvement in medium- to long-term response rates (32.1% IONM vs. 23.7% non-IONM).
- Lower rates of neurological dysfunction deterioration in the IONM group (3.3% vs. 8.5%) in the long term.
Conclusions:
- IONM does not significantly enhance short-term outcomes or reduce immediate postoperative neurological dysfunction after tethered cord release.
- IONM is associated with better medium- to long-term prognoses in pediatric patients undergoing tethered cord release surgery.
Objective:
The objective of this study was to explore the effect of intraoperative neurophysiological monitoring (IONM) on tethered spinal cord release in children.
Methods:
The clinical data of 454 children with tethered cord syndrome who underwent surgery for tethered cord release were retrospectively analyzed. The children were divided into two groups: the non-IONM group and the IONM group. SPSS 26.0 software was used for statistical analysis. The evaluation indices included the effective rate and incidence of new neurological dysfunction.
Results:
The short-term results showed that the effective rate of the non-IONM group was 14.8%, while that of the IONM group was 15.2%. Additionally, the incidence of new neurological dysfunction was 7.8% in the non-IONM group and 5.6% in the IONM group. However, there was no significant difference between the two groups (P > 0.05). The medium- to long-term follow-up had significant difference (P < 0.05), the response rate was 32.1% in the IONM group and 23.7% in the non-IONM group, and deterioration rates regarding neurological dysfunction were 3.3% in the IONM group and 8.5% in the non-IONM group.
Conclusion:
This study revealed that the use of IONM does not significantly improve the short-term treatment effect of patients undergoing surgery for tethered cord release or reduce the short-term incidence of postoperative new neurological dysfunction. However, the medium- to long-term prognoses of patients in the IONM group were better than those of patients in the non-IONM group.
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