Differentiating Neurological Tissue From Non-Neurological Tissue in Tethered Cord Release Surgery
By Admin | October 05, 2023
Take a moment to imagine the consequences of the spinal cord being abnormally anchored to the tissues surrounding the spine. It would prevent the spinal cord from moving with the spine as it grows. A person with this condition would need a delicate, immediate surgery.
The condition is known as a tethered cord and the patient was a 7-month-old female. Compounding the condition, our patient also exhibited a lumbosacral lipoma. Remarkably, this patient exhibited no symptoms, underscoring the potential of early medical intervention.
The solution is a tethered cord release surgery, a procedure that liberates the spinal cord from its restrictive surroundings, allowing it to grow and develop unimpeded. In this intricate procedure, neuromonitoring provided a critical service in ensuring the spinal cord's integrity and allowing the surgeon to distinguish between nervous and non-nervous tissues.
Within the operating room, several neuromonitoring techniques came together to safeguard the spinal cord's integrity and provide the opportunity for a positive outcome. Those techniques included, Somatosensory Evoked Potentials (SSEPs), Motor Evoked Potentials (MEPs), Spontaneous Electromyography (sEMG), the Bulbocavernosus Reflex (BCR), and the H-Reflex joined forces.
Another technique, Triggered Electromyography (tEMG), allowed the surgical team to distinguish neurological tissue from non-neurological tissue. Employing this specific tool prevented potentially harming the spinal cord during the lipoma's removal.
As the procedure unfolded, Triggered EMG helped to identify the filum, a slender but significant structure within the spinal cord. The responses in the sphincters provided invaluable guidance, assisting the surgeon in identifying sacral nerve roots that should not be resected.
With the surgery's conclusion, SSEPs, MEPs, BCR, and H-Reflex, all displayed normal responses, painting a reassuring picture of minimal postoperative deficits.
Consider a scenario where neuromonitoring was absent, and the surgeon navigated the delicate terrain of the cauda equina without real-time insights. Without neuromonitoring's guidance, distinguishing between neurological and non-neurological tissues could have become a perilous guessing game. The consequences might have included inadvertent damage to the spinal cord during the lipoma's removal, jeopardizing the patient.
During this tethered cord release surgery, neuromonitoring helped uphold the patient's safety and well-being. It helped protect the spinal cord's integrity and allowed the surgical team to differentiate between vital neurological tissues and non-neurological structures.
At Axis Neuromonitoring, we are committed to high-quality intraoperative neurophysiological monitoring (IONM) and its ability to improve patient outcomes. For more information about the transformative benefits of neuromonitoring and its impact on surgical outcomes, please contact us at 888-344-2947.
