The value of intraoperative neurophysiological monitoring in tethered cord surgery

Eelco W Hoving, Esther Haitsma, Charlotte M C Oude Ophuis, Henricus L Journée

Onderzoeksoutput: Bijdrage aan tijdschriftArtikelpeer review

34 Citaten (Scopus)


PURPOSE: The value of intraoperative neurophysiological monitoring (IONM) with surgical detethering in dysraphic patients has been questioned. A retrospective analysis of our series of 65 patients is presented with special focus on technical set-up and outcome.

METHODS: All patients were diagnosed with a tethered cord (TC) due to spinal dysraphism. A high-risk group (HRG) was determined consisting of 40 patients with a lipomyelomeningocele and/or a split cord malformation sometimes in combination with a tight filum terminale. The surgical procedure was a detethering operation in all cases performed by a single surgeon during a 9-year period (1999-2008). A standard set-up of IONM was used in all patients consisting of motor-evoked potentials (MEP) evoked by transcranial electrical stimulation (TES) and electrical nerve root stimulation. In young patients, conditioning stimulation was applied in order to improve absent or weak MEPs.

RESULTS: IONM responses could be obtained in all patients. Postoperative deterioration of symptoms was found in two patients of whom one patient belonged to the HRG. Mean maximal follow-up of all 65 patients was 4.6 years (median 4.1 years). Long-term deterioration of symptoms was found in 6 of 65 patients with a mean follow-up of 5 years (median 5.3 years).

CONCLUSION: The use of IONM is feasible in all TC patients. The identification of functional nervous structures and continuous guarding of the integrity of sacral motor roots by IONM may contribute to the safety of surgical detethering.

Originele taal-2Engels
Pagina's (van-tot)1445-52
Aantal pagina's8
TijdschriftChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
Nummer van het tijdschrift9
StatusGepubliceerd - sep. 2011
Extern gepubliceerdJa


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