Adding Modalities, Improving Outcomes for Patients with Tethered Cord Syndrome
By Admin | May 10, 2019
Researchers once thought that tethered spinal cord syndrome, also known as tethered cord syndrome or TCS, only affected children diagnosed with spina bifida. But although statistics show that between 20 and 50 percent of children with TCS do have spinal bifada, a congenital abnormality of the spine, adults and children without the condition can have TCS, too.
TCS is caused when tissue in the spinal cord attaches to the spinal column and limits the movement of the spinal cord. This can cause spinal cord stretching, which cuts off blood supply to the spinal cord and creates a host of life-altering side effects.
The effects of TCS include leg pain, tingling and numbness in the legs, loss of leg strength, change in gait and mobility, and uncontrollable repeated muscle contractions. Individuals living with TCS also often experience leg deformities, spine tenderness and back pain, curvature of the spine (scoliosis), and in many cases, bowel and bladder control issues.
If left untreated, TCS can cause additional strain on the spinal cord, resulting in sensory and motor problems and loss of bladder and bowel control.
Surgical Solutions
T
he primary treatment for TCS is surgery to disconnect or untether the spinal cord. As with any procedure, there are risks of complications, but complications during the surgery can be minimized through active observation of the patient using a clinical procedure known as intraoperative neurophysiological monitoring or neuromonitoring.
"During neuromonitoring, patients undergoing surgery are evaluated using diagnostic tools to track neural activity. Neuromonitoring is especially useful for patients undergoing spinal procedures, including surgeries to correct tethered spinal cords also known as tethered cord release (TCR)," said Dr. Faisal Jahangiri, CNIM, D. ABNM, FASNM, vice president of clinical affairs at AXIS Neuromonitoring.
Neuromonitoring is especially useful in understanding and monitoring how TCR surgery can affect the nerves that control bowel and bladder function.
"The nerves controlling these functions are at risk and can be negatively impacted during surgery," Jahangiri said.
To mitigate negative impacts, these nerves are monitored using diagnostic tools such as electromyography (EMG), somatosensory evoked potentials (SSEP) and transcranial electrical motor evoked potentials, also known as TCeMEPs, collected from the external anal sphincter muscles.
While these modalities can provide neuromonitoring technologists some information during the TCR surgery, Jahangiri and other researchers believe that taking neuromonitoring of patients during this spinal cord procedure a step further can reduce damage to the nerves controlling these operations and help prevent bowel and bladder dysfunction caused by surgery.
In a multicenter study recently published in The Neurodiagnostic Journal, Jahangiri and a team of researchers tested a new way of collecting information during TCR surgery to monitor changes in the bladder.
Using a catheter embedded with an electrode inserted into the urethra, the researchers collected neurological data from 15 patients undergoing spinal procedures, of which four were tethered cord releases.
This approach allowed them to collect more information from the patients during their procedure, recording muscle, and neural activity.
"Adding in the neuromonitoring via urethral catheter electrode gave us an additional way to make sure patients were safe during their TCR procedure," Jahangiri said.
AXIS Neuromonitoring is based in Richardson, Texas, and provides intraoperative neuromonitoring services throughout the state.
Source: Faisal R. Jahangiri, Justin W. Silverstein, Courtney Trausch, Sami Al Eissa, Zachariah M. George, Hargovind DeWal & Izabela Tarasiewicz (2019) Motor Evoked Potential Recordings from the Urethral Sphincter Muscles (USMEPs) during Spine Surgeries. The Neurodiagnostic Journal, 59;1, 34-44.
