Beyazova Mehmet, Zinnuroglu Murat, Emmez Hakan, Kaya Kadir, Ozkose H Zerrin, Baykaner M Kemali, Erden Zeynep, Orucoglu Nurdan, Ozturk Gokhan Tuna, Erdogan Zeynep
Gazi University, Department of Physical Medicine and Rehabilitation Ankara, Turkey.
Turk Neurosurg. 2010 Oct;20(4):480-4. doi: 10.5137/1019-5149.JTN.3314-10.1.
The tethered cord syndrome refers to a variety of lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Permanent or temporary neurological complications were reported following surgical release. In this report, peri- and postoperative results in cases with tethered cord syndrome that were followed by multimodal intraoperative neurophysiological monitoring (MIONM) methods are presented.
An IONM system (Nicolet CR Endeavor) was used for monitoring during tethered cord surgery. Somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), direct nerve root/rootlet stimulation, free-run electromyography (EMG) and F-waves were used during tethered cord surgery of 10 cases to prevent possible nerve injuries.
MEP and SEP recordings did not change in any of the cases during surgery. The nervous tissue was identified and differentiated from connective tissue in three cases when motor responses were elicited with direct stimulation of nerve roots. None of the cases had neurological deficits following the operation.
Direct nerve root/rootlet stimulation should be one of the components of MIONM during surgery for tethered cord syndrome to prevent postoperative neurological deficits.
脊髓拴系综合征是指可导致脊髓圆锥低位或在椎管内活动受限的多种病变。据报道，手术松解后会出现永久性或暂时性神经并发症。在本报告中，介绍了采用多模式术中神经生理监测（MIONM）方法对脊髓拴系综合征病例进行围手术期及术后的结果。
在脊髓拴系手术期间使用IONM系统（Nicolet CR Endeavor）进行监测。在10例脊髓拴系手术中，采用体感诱发电位（SEP）、运动诱发电位（MEP）、直接神经根/神经根丝刺激、自由运行肌电图（EMG）和F波来预防可能的神经损伤。
手术过程中所有病例的MEP和SEP记录均未发生变化。当直接刺激神经根引发运动反应时，3例病例中神经组织得以识别并与结缔组织区分开来。术后所有病例均无神经功能缺损。
在脊髓拴系综合征手术中，直接神经根/神经根丝刺激应作为MIONM的组成部分之一，以预防术后神经功能缺损。
