Intraoperative Neurophysiological Monitoring in Tethered Cord Syndrome: Clinical Experience with 30 Cases

Objective: The tethered cord syndrome (TCS) refers to lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Tight conus medullaris is untethered by microneurosurgical operation. Patients may have additional persistent or transient neurological deficits in postoperative follows. The use of intraoperative neurophysiological monitoring (IONM) reduces risks of being neurological deficits. In our article, we aimed to show the importance of using intraoperative neurophysiological monitoring with results of cases operated in our department.Material and Methods: The results of IONM findings, preoperative and postoperative neurological findings of 30 patients who were operated in our clinic between 2015-2016 were reported. Intraoperative neurophysiological monitoring (IONM) was used in all cases with tethered cord sydrome. Somatosensory evoked potential (SEP), motor evoked potential (MEP), free-run EMG responses, external sphincter muscle MEP and direct monopolar probe-evoked potentials were recorded.Results: There were 20 male and 10 female patients with a mean age of 9.03 in our study. There was an increase in SEP values in only one of the cases. Additional neurological deficit arised in three cases; 1 transient (48 hours) and 2 persistent.Conclusion: As our and other studies in literature has shown that using appropriate monitorization with experienced team decreases the risk of developing neurological injury; IONM should be used with its all modalities.