Surgical Outcomes of Tethered Cord Release Under Intraoperative Neuromonitoring in Patients with Tethered Cord Syndrome

Abstract

Objective:  To analyze the efficacy of intraoperative neurophysiological monitoring (IONM) to keep the patient neurologically functional during surgical management of Tethered Cord Syndrome (TCS).

Material and Methods:  The retrospective study was done on 40 patients of tethered cord release in Khyber Teaching Hospital, Peshawar, during March 2024 to February 2025. Transcranial motor evoked potentials (TcMEPs), tibial nerve somatosensory evoked potentials (TNSEPs), and pudendal anal reflex (PAR) were used as intraoperative monitoring. Pre and postoperative evaluations were done on motor strength, sensory, and bladder/anal control. The Fisher Exact Test was used to carry out statistical analysis with a p-value of < 0.05.

Results:  The average time of follow-up of patients (mean age: 20.14 +/- 11.96 years) was 8.41 months. The success monitoring was 95 percent in TcMEPs, 72.5 percent in TNSEPs, and 82.5 percent in PAR. In 7.5 percent of cases, transient deficits were reported. TcMEPs had a sensitivity and specificity of 100 percent to predict motor outcomes. TNSEPs were highly correlated with sensory changes (p = 0.049), whereas PAR was not significantly correlated with bladder dysfunction (p = 0.497). There were no significant complications.

Conclusion:  Multimodal IONM of tethered cord surgery promotes intraoperative safety and contributes to the maintenance of motor and sensory functions. TcMEPs were very accurate in the determination of motor outcome, whereas TNSEPs were very informative in the determination of sensory activity.