The Outcome of Neurophysiologically Assisted Tethered Cord Syndrome Surgery

Background: Tethered cord syndrome (TCS) is a collection of neurological deficits that arise from an ongoing tethering of the spinal cord by different structures, which requires untethering.Objective: To evaluatethe results of intraoperative neurophysiological monitoring during untethering and to address the issue of timing of surgery.Patients and Methods: Thirty cases with either primary or secondary tethered cords were included. The diagnosis was based on the clinical picture, and spine magnetic resonance imaging (MRI) and computerized tomography (CT) were done for all cases. A urodynamic study was done in voiding dysfunction patients. All modalities of electrophysiological monitoring were utilized intraoperatively under total intravenous anesthesia.Results: Only three cases showed additional postoperative deficits. The postoperative improvement was 80% in low back pain, 50% in motor deficits, and 40% in neurogenic bladder dysfunction. Neurogenic bowel dysfunction was present in only one case, with marked postoperative improvement.Conclusion: The tethered cord should be untethered as early as possible, and intraoperative neurophysiological monitoring (IONM) should be utilized with all its modalities to minimize the risk of injury to the neurological structures.