Our Summary

This research paper presents a study on treating tethered cord syndrome (TCS), a condition where the spinal cord is abnormally attached within the spine. This condition can cause nerve damage, so during surgery, it’s important to identify a specific part of the spinal cord called the filum terminale.

In this study, 26 patients with TCS, ranging in age from one to 56 years old, were observed. The researchers used different types of nerve monitoring methods during surgery, specifically, triggered electromyography (t-EMG), transcranial motor evoked potential (TcMEP), and free-running electromyography (f-EMG).

Results showed that these methods were successful in identifying the filum terminale and nerve roots, and no new post-surgery nerve damage occurred. Additionally, the study found that TcMEP is a good predictor of continued muscle function.

The findings suggest that using these nerve monitoring methods during TCS surgery can help prevent post-surgery complications, and their use should be encouraged.

FAQs

  1. What is tethered cord syndrome (TCS) and why is it important to identify the filum terminale during surgery?
  2. What nerve monitoring methods were used in the study to identify the filum terminale and nerve roots during TCS surgery?
  3. What were the main findings of the study on treating tethered cord syndrome and how can these methods help prevent post-surgery complications?

Doctor’s Tip

One helpful tip a doctor might tell a patient about detethering surgery is to discuss the importance of nerve monitoring during the procedure. This can help ensure that the surgery is conducted safely and effectively, minimizing the risk of nerve damage and potential complications. It is important for patients to understand the role of nerve monitoring in detethering surgery and to ask their healthcare provider about the specific methods that will be used during their procedure.

Suitable For

Patients who are typically recommended detethering surgery for TCS are those who are experiencing symptoms such as back pain, leg pain, weakness or numbness in the legs, difficulty walking, urinary or bowel dysfunction, and scoliosis. These symptoms may indicate that the spinal cord is being compressed or stretched due to the abnormal attachment within the spine.

Additionally, patients who have been diagnosed with TCS through imaging tests such as MRI or ultrasound may also be recommended for detethering surgery. The decision to undergo surgery is typically made based on the severity of symptoms and the likelihood of progression of the condition.

Overall, patients who are experiencing symptoms of TCS and have been diagnosed with the condition through imaging tests are typically recommended detethering surgery to prevent further nerve damage and improve their quality of life.

Timeline

Before detethering surgery:

  • Patient may experience symptoms such as back pain, leg weakness, bladder or bowel dysfunction, and changes in gait.
  • Patient undergoes imaging tests such as MRI to diagnose TCS.
  • Patient may undergo conservative treatments such as physical therapy or medication to manage symptoms.

After detethering surgery:

  • Patient undergoes pre-operative evaluations and tests to assess the severity of TCS.
  • During surgery, nerve monitoring methods such as t-EMG, TcMEP, and f-EMG are used to identify the filum terminale and nerve roots.
  • Surgery is performed to release the tethered spinal cord and relieve pressure on the nerves.
  • Post-surgery, patient may experience some pain and discomfort, but this should improve over time.
  • Patient undergoes post-operative follow-up appointments to monitor progress and address any complications.
  • Patient may need physical therapy or rehabilitation to regain strength and function in affected areas.

What to Ask Your Doctor

Some questions a patient should ask their doctor about detethering surgery may include:

  1. What is tethered cord syndrome and how does it affect me?
  2. Why do I need detethering surgery?
  3. What are the risks and benefits of the surgery?
  4. What nerve monitoring methods will be used during the surgery?
  5. How do these nerve monitoring methods help in identifying the filum terminale and nerve roots?
  6. What is the success rate of using these nerve monitoring methods in preventing post-surgery complications?
  7. How long is the recovery process after detethering surgery?
  8. What are the potential complications and side effects of the surgery?
  9. Will I need physical therapy or ongoing treatment after the surgery?
  10. Are there any lifestyle changes I need to make to support my recovery after detethering surgery?

Reference

Authors: Gadhvi MA, Baranwal A, Srivastav S, Garg M, Jha DK, Dixit A. Journal: Maedica (Bucur). 2023 Sep;18(3):399-403. doi: 10.26574/maedica.2023.18.3.399. PMID: 38023758