The Indispensable Role of Intraoperative Neurophysiological Monitoring in Tethered Cord Release Surgeries

Untethering of the spinal cord is performed to surgically treat abnormal spinal cord fixation, which tends to arise from conditions such as spina bifida, spinal dysmorphisms (including diastematomyelia, lipomyelomeningocele, and myelomeningocele), trauma, or tumors. This fixation often leads to complications known as Tethered Cord Syndrome (TCS), where the spinal cord becomes abnormally anchored, resulting in restricted mobility and progressive neurological deficits [1]. Surgical untethering aims to prevent further damage or potentially reverse symptoms, with intraoperative neuromonitoring (IONM) playing a vital role in distinguishing functional neural tissue from fibrous tissue to reduce the risk of nerve damage.