Elsevier

Journal of Clinical Neuroscience

Volume 71, January 2020, Pages 205-212
Journal of Clinical Neuroscience

Clinical study
Clinical observations on the release of tethered spinal cord in children with intra-operative neurophysiological monitoring: A retrospective study

https://doi.org/10.1016/j.jocn.2019.07.080Get rights and content

Highlights

Abstract

To study the utility of neurophysiological monitoring in the micro-surgical treatments on children with Tethered Cord Syndrome (TCS). A total of 100 patients were included in this study. 51 children underwent micro-surgical treatments without neurophysiological monitoring (no monitoring group) from 2004 to 2009, whereas 49 children with neurophysiological monitoring (monitoring group) from 2010 to 2016. Postoperative evaluations demonstrated that more children in monitoring group (39, 80%) achieved total release than no monitoring group (36, 71%). Fewer new complications (9, 18%) were found in children of monitoring group than that of no monitoring group (19, 37%) (χ2 = 4.422, P < 0.05). Additionally, more children in monitoring group (34, 76%) achieved complete recovery or significant improvement than that of no monitoring group (24, 54%) (χ2 = 4.326, P < 0.05). This retrospective study provided the evidence supporting the hypothesis that intra-operative neurophysiological monitoring may better guide the surgical process, reduce the risk of post-operative complications, and improve the recovery of children with TCS.

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).

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    These authors contribute equally to this work.

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