Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults

Alfredo Quinones-Hinojosa, Chirag A. Gadkary, Mittul Gulati, Cornelia S. Von Koch, Russ Lyon, Phillip R. Weinstein, Charles D. Yingling

Research output: Contribution to journalReview article

48 Citations (Scopus)

Abstract

Background Release of tethered spinal cord by sectioning of the filum terminale carries a significant risk of injury to the neighboring motor and sensory nerve roots. Intraoperative neurophysiological monitoring techniques can help to minimize these adverse neurologic outcomes. Methods We performed a retrospective review of 67 consecutive patients undergoing tethered cord release. We excluded 52 pediatric patients which limited our study to 15 adult patients treated during a four year period, including patients with a thick filum, low lying conus, myelomeningocele, filum tumor, spinal cord malformation, and/or lipoma. Clinical outcomes were determined from postoperative follow-up visits. Two patients were lost to follow up and were excluded from the clinical outcome analysis. Electrical stimulation of the filum terminale and lumbo-sacral nerve roots in conjunction with electromyogram (EMG) recording was performed intraoperatively. Results The mean electrical threshold for EMG response during stimulation of the filum terminale was 37.1 volts (V), range 15 to 100 V. In comparison, the lowest threshold obtained by direct stimulation of the ventral nerve roots was a mean of 1.46 V, with a range of 0.1 to 7 V. More than 70% of the patients studied demonstrated a filum to motor root threshold ratio of 100:1 or greater. No patient developed new neurologic symptoms or signs postoperatively. Bowel and bladder function improved in 46% of patients, back pain in 39% and motor function in 31%. Eight percent reported decline in bladder control and worsening back pain postoperatively. Conclusions The often dramatic difference in the threshold of the filum terminale and adjacent motor nerve roots (100:1) helps to identify, isolate, and safely section the filum terminale. Tethered cord release using intraoperative neurophysiological monitoring is safe and in the majority of cases leads to improvement or at least, stabilization of neurologic function. Monitoring prevented intraoperative nerve root injury that might have resulted in immediate onset of new neurologic deficits caused by the surgical procedure.

Original languageEnglish (US)
Pages (from-to)127-133
Number of pages7
JournalSurgical Neurology
Volume62
Issue number2
DOIs
StatePublished - Aug 2004
Externally publishedYes

Fingerprint

Neurophysiological Monitoring
Neural Tube Defects
Cauda Equina
Intraoperative Neurophysiological Monitoring
Electromyography
Back Pain
Neurologic Manifestations
Nervous System
Urinary Bladder
Spinal Cord Neoplasms
Intraoperative Monitoring
Meningomyelocele
Spinal Nerve Roots
Lipoma
Lost to Follow-Up
Wounds and Injuries
Electric Stimulation
Spinal Cord
Pediatrics

Keywords

  • adult presentation
  • electrophysiology
  • monitoring
  • outcome
  • Tethered cord syndrome

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Quinones-Hinojosa, A., Gadkary, C. A., Gulati, M., Von Koch, C. S., Lyon, R., Weinstein, P. R., & Yingling, C. D. (2004). Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. Surgical Neurology, 62(2), 127-133. https://doi.org/10.1016/j.surneu.2003.11.025

Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. / Quinones-Hinojosa, Alfredo; Gadkary, Chirag A.; Gulati, Mittul; Von Koch, Cornelia S.; Lyon, Russ; Weinstein, Phillip R.; Yingling, Charles D.

In: Surgical Neurology, Vol. 62, No. 2, 08.2004, p. 127-133.

Research output: Contribution to journalReview article

Quinones-Hinojosa, A, Gadkary, CA, Gulati, M, Von Koch, CS, Lyon, R, Weinstein, PR & Yingling, CD 2004, 'Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults', Surgical Neurology, vol. 62, no. 2, pp. 127-133. https://doi.org/10.1016/j.surneu.2003.11.025
Quinones-Hinojosa, Alfredo ; Gadkary, Chirag A. ; Gulati, Mittul ; Von Koch, Cornelia S. ; Lyon, Russ ; Weinstein, Phillip R. ; Yingling, Charles D. / Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. In: Surgical Neurology. 2004 ; Vol. 62, No. 2. pp. 127-133.
@article{e3bdf0c6ef614297b94b03642b72f856,
title = "Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults",
abstract = "Background Release of tethered spinal cord by sectioning of the filum terminale carries a significant risk of injury to the neighboring motor and sensory nerve roots. Intraoperative neurophysiological monitoring techniques can help to minimize these adverse neurologic outcomes. Methods We performed a retrospective review of 67 consecutive patients undergoing tethered cord release. We excluded 52 pediatric patients which limited our study to 15 adult patients treated during a four year period, including patients with a thick filum, low lying conus, myelomeningocele, filum tumor, spinal cord malformation, and/or lipoma. Clinical outcomes were determined from postoperative follow-up visits. Two patients were lost to follow up and were excluded from the clinical outcome analysis. Electrical stimulation of the filum terminale and lumbo-sacral nerve roots in conjunction with electromyogram (EMG) recording was performed intraoperatively. Results The mean electrical threshold for EMG response during stimulation of the filum terminale was 37.1 volts (V), range 15 to 100 V. In comparison, the lowest threshold obtained by direct stimulation of the ventral nerve roots was a mean of 1.46 V, with a range of 0.1 to 7 V. More than 70{\%} of the patients studied demonstrated a filum to motor root threshold ratio of 100:1 or greater. No patient developed new neurologic symptoms or signs postoperatively. Bowel and bladder function improved in 46{\%} of patients, back pain in 39{\%} and motor function in 31{\%}. Eight percent reported decline in bladder control and worsening back pain postoperatively. Conclusions The often dramatic difference in the threshold of the filum terminale and adjacent motor nerve roots (100:1) helps to identify, isolate, and safely section the filum terminale. Tethered cord release using intraoperative neurophysiological monitoring is safe and in the majority of cases leads to improvement or at least, stabilization of neurologic function. Monitoring prevented intraoperative nerve root injury that might have resulted in immediate onset of new neurologic deficits caused by the surgical procedure.",
keywords = "adult presentation, electrophysiology, monitoring, outcome, Tethered cord syndrome",
author = "Alfredo Quinones-Hinojosa and Gadkary, {Chirag A.} and Mittul Gulati and {Von Koch}, {Cornelia S.} and Russ Lyon and Weinstein, {Phillip R.} and Yingling, {Charles D.}",
year = "2004",
month = "8",
doi = "10.1016/j.surneu.2003.11.025",
language = "English (US)",
volume = "62",
pages = "127--133",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults

AU - Quinones-Hinojosa, Alfredo

AU - Gadkary, Chirag A.

AU - Gulati, Mittul

AU - Von Koch, Cornelia S.

AU - Lyon, Russ

AU - Weinstein, Phillip R.

AU - Yingling, Charles D.

PY - 2004/8

Y1 - 2004/8

N2 - Background Release of tethered spinal cord by sectioning of the filum terminale carries a significant risk of injury to the neighboring motor and sensory nerve roots. Intraoperative neurophysiological monitoring techniques can help to minimize these adverse neurologic outcomes. Methods We performed a retrospective review of 67 consecutive patients undergoing tethered cord release. We excluded 52 pediatric patients which limited our study to 15 adult patients treated during a four year period, including patients with a thick filum, low lying conus, myelomeningocele, filum tumor, spinal cord malformation, and/or lipoma. Clinical outcomes were determined from postoperative follow-up visits. Two patients were lost to follow up and were excluded from the clinical outcome analysis. Electrical stimulation of the filum terminale and lumbo-sacral nerve roots in conjunction with electromyogram (EMG) recording was performed intraoperatively. Results The mean electrical threshold for EMG response during stimulation of the filum terminale was 37.1 volts (V), range 15 to 100 V. In comparison, the lowest threshold obtained by direct stimulation of the ventral nerve roots was a mean of 1.46 V, with a range of 0.1 to 7 V. More than 70% of the patients studied demonstrated a filum to motor root threshold ratio of 100:1 or greater. No patient developed new neurologic symptoms or signs postoperatively. Bowel and bladder function improved in 46% of patients, back pain in 39% and motor function in 31%. Eight percent reported decline in bladder control and worsening back pain postoperatively. Conclusions The often dramatic difference in the threshold of the filum terminale and adjacent motor nerve roots (100:1) helps to identify, isolate, and safely section the filum terminale. Tethered cord release using intraoperative neurophysiological monitoring is safe and in the majority of cases leads to improvement or at least, stabilization of neurologic function. Monitoring prevented intraoperative nerve root injury that might have resulted in immediate onset of new neurologic deficits caused by the surgical procedure.

AB - Background Release of tethered spinal cord by sectioning of the filum terminale carries a significant risk of injury to the neighboring motor and sensory nerve roots. Intraoperative neurophysiological monitoring techniques can help to minimize these adverse neurologic outcomes. Methods We performed a retrospective review of 67 consecutive patients undergoing tethered cord release. We excluded 52 pediatric patients which limited our study to 15 adult patients treated during a four year period, including patients with a thick filum, low lying conus, myelomeningocele, filum tumor, spinal cord malformation, and/or lipoma. Clinical outcomes were determined from postoperative follow-up visits. Two patients were lost to follow up and were excluded from the clinical outcome analysis. Electrical stimulation of the filum terminale and lumbo-sacral nerve roots in conjunction with electromyogram (EMG) recording was performed intraoperatively. Results The mean electrical threshold for EMG response during stimulation of the filum terminale was 37.1 volts (V), range 15 to 100 V. In comparison, the lowest threshold obtained by direct stimulation of the ventral nerve roots was a mean of 1.46 V, with a range of 0.1 to 7 V. More than 70% of the patients studied demonstrated a filum to motor root threshold ratio of 100:1 or greater. No patient developed new neurologic symptoms or signs postoperatively. Bowel and bladder function improved in 46% of patients, back pain in 39% and motor function in 31%. Eight percent reported decline in bladder control and worsening back pain postoperatively. Conclusions The often dramatic difference in the threshold of the filum terminale and adjacent motor nerve roots (100:1) helps to identify, isolate, and safely section the filum terminale. Tethered cord release using intraoperative neurophysiological monitoring is safe and in the majority of cases leads to improvement or at least, stabilization of neurologic function. Monitoring prevented intraoperative nerve root injury that might have resulted in immediate onset of new neurologic deficits caused by the surgical procedure.

KW - adult presentation

KW - electrophysiology

KW - monitoring

KW - outcome

KW - Tethered cord syndrome

UR - http://www.scopus.com/inward/record.url?scp=3142740805&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=3142740805&partnerID=8YFLogxK

U2 - 10.1016/j.surneu.2003.11.025

DO - 10.1016/j.surneu.2003.11.025

M3 - Review article

C2 - 15261505

AN - SCOPUS:3142740805

VL - 62

SP - 127

EP - 133

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

IS - 2

ER -