Clinical studyClinical observations on the release of tethered spinal cord in children with intra-operative neurophysiological monitoring: A retrospective study
Introduction
Tethered Cord Syndrome (TCS) is a clinical entity that presents with neurological, urological and orthopedic symptoms caused by tethering of the spinal cord [1]. It was firstly introduced by Hoffman in 1976 [2] and it is generally diagnosed in childhood [3], [4]. Children with TCS may often have congenital structure abnormalities of spine and spinal cord, such as spinal cord cone low, shortened and thickened intradural filum terminale, fibrous adhesions or lipoma of the filum terminale, which limit the activity of spinal cord [5], [6], [7]. A progressive dysfunction process will arise including dysuria, lower limb and foot deformities paralysis clinically [8]. Early diagnosis and untethering can be done to reduce the potential lifelong disabilities [9]. The disease is high in incidence and morbidity for children. The complex surgery, high rate of postoperative complication and the overall poor efficacy had aroused great concerns of neurosurgeons.
Currently, the researchers found that surgical outcome mainly depends on some of the following aspects, such as the anatomical complexity, the clinical presentation before untethering. In addition, the most important one is the complete untether rate during the surgery. For some types of tethered cord like lipomyelomeningoceles, surgical risks and morbidity are very high.
Some researchers have mentioned that neurophysiological studies of the patients in preoperative and postoperative periods are crucial in order to objectively evaluate the patients [9], [10]. Additionally, intra-operative neurophysiological monitoring may also have a certain effect to offer guidance to the surgical process and help control post-operative complications and improve the recovery rate. As the neurophysiological monitoring technique was introduced into our hospital in 2009, so we chose 2 time periods of 2004–2009 and 2010–2016 as our observation intervals in which 51 and 49 children with TCS were admitted to our hospital and underwent surgeries, they were included into the retrospective study on the purpose of studying the role of neurophysiological monitoring in the surgical treatments on children with TCS.
Section snippets
Patients
All patients in this study are from the Spine Center of the affiliated hospital of Logistics university of People's Armed Police Forces. All patients underwent MRI scan to confirm the diagnosis of tethered spinal cord. The diagnosis of cord tethering was confirmed by a qualified neuroradiologist and a neurosurgeon. 49 patients (26 female and 23 males, aged 3 months to 12 years, mean age of 9.2 years) with TCS were treated between January 1st, 2010 and December 31st, 2016. Neurophysiological
Surgical findings and effects
There was no significant difference in the gender, age, clinical symptoms between the 2 groups before surgery (P > 0.05). By using Logistics regression analysis, age and sex were not independent risk factors in this study (P > 0.05). No significant differences were found in preoperative Hoffmann neurological grading and postoperative pathological finding between the two groups (P > 0.05) (Fig 2, Fig. 3). Which proves that no additional bias will affect this study. Postoperative pathological
Discussion
The surgical management of TCS is challenging because of the complex anatomy, and risk of lower limb paralysis, incontinence, and central nervous system infection [12]. The goal of surgery is to preserve neurological function, reconstruct spinal abnormalities, ensure the normal circulation of cerebrospinal fluid, and prevent progressive neurological dysfunction. Early and effective surgery can significantly improve quality of life.
Surgical detethering of the spinal cord is currently the gold
Ethics statement
The owners of clinical cases described in this study gave informed consent for the diagnostic procedures, treatment, and use of clinical data, such as medical history, imaging studies, and intraoperative pictures for research and publication purposes. All owners were informed, ethical issues do not exist in this study.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
This work was supported by the National Key Research and Development Plan of China (2016YFC1101500) and The National Natural Science Foundation of China (11672332, 11102235, 31200809).
References (33)
- et al.
Early identification of tethered cord syndrome: a clinical challenge
J Pediatr Health Care
(2014) - et al.
Spinal cord traction, vascular compromise, hypoxia, and metabolic derangements in the pathophysiology of tethered cord syndrome
Neurosurg Focus
(2010) - et al.
The tethered spinal cord: its protean manifestations, diagnosis and surgical correction
Childs Brain
(1976) - et al.
Tethered cord syndrome in adulthood
J Spinal Cord Med
(2008) - et al.
Comparison of electrophysiological outcomes of tethered cord syndrome and spinal intradural tumors: a retrospective clinical study
Turk Neurosurg
(2017) - et al.
Recurrent tethered cord syndrome: a novel approach for a difficult surgical condition
J Neurosurg Spine
(2009) - et al.
Tethered cord syndrome: a review of the literature from embryology to adult presentation
Neurosurg Focus
(2010) - et al.
Management of adult tethered cord syndrome: our experience and review of literature
Neurol India
(2014) - et al.
Minimally invasive endoscopic spinal cord untethering: case report
J Spine Surg
(2017) - et al.
Tethered cord syndrome in childhood: special emphasis on the surgical technique and review of the literature with our experience
Turk Neurosurg
(2011)
Utility of neurophysiology in the diagnosis of tethered cord syndrome
J Neurosurg Pediatr
Management of lipomyelomeningoceles. experience at the hospital for sick children
Toronto J Neurosurg
Comparative study of untethering and spine-shortening surgery for tethered cord syndrome in adults
Global Spine J
Long-term outcomes of surgical treatment for tethered cord syndrome
J Spinal Disord Tech
Occult tight filum terminale syndrome: results of surgical untethering
Pediatr Neurosurg
Prognostic factors affecting urologic outcome after untethering surgery for lumbosacral lipoma
Childs Nerv Syst
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These authors contribute equally to this work.