Intraoperative Monitoring in Tethered Cord Surgery

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Abstract

The tethered cord syndrome is caused by abnormal fixation of the spinal cord with resultant reduction in blood flow leading to impaired oxidative metabolism of the grey matter. Etiologies include embryological derangement, trauma, and surgery. Common symptoms include but are not limited to pain, weakness, loss of sensation, and bowel/bladder dysfunction. Surgical release allows normalization of blood flow and then parallel neurological improvement. Goals of neurosurgery to correct tethered cord are full release of restricted tissue and preservation of involved neural structures. Because of difficulty identifying neural elements based on anatomic appearance, multimodality neurophysiologic monitoring is employed to minimize risk and preserve function, especially bowel and bladder control. A technique using spontaneous and evoked electromyography, somatosensory-evoked potentials, motor-evoked potentials, bulbocavernosus reflex elicitation, and bladder pressure urometry was successfully integrated into the surgical release of this patient’s tethered cord.

Keywords

IOM Tethered cord surgery Tethered cord syndrome (TCS) Anesthetic management Intraoperative neuromonitoring Somatosensory-evoked potentials Transcranial motor-evoked potentials Electromyography, bladder pressure urometry Bulbocavernosus reflex 
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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of Colorado School of MedicineAuroraUSA

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