Tetheral spinal cord surgery including neurophysiological assessment

Abstract

Tethered spinal cord syndrome (MA) includes a group of pathological conditions that determine that the conus medullaris was in an unusually lower level and fixed, in a relative state of immobility.
Confusing anatomo-surgical conditions are regularly found when surgeries of lumbar and sacral spinal disraphic injuries are on course.
In some cases, roots are enclosed by the arachnoid, simulating a thick filum terminale; in other cases, the transition between a functional but structurally distorted conus and a lipoma of the filum may not be clear: neurological function may be at risk in case of section procedures solely using morphological criteria. This leads not only to an increase of morbility, but also to the permanence of the pathologic disorder.
Surgery –using a neurophysiologic intrasurgical record– of myotomes of sacral and lumbar roots before the section of the tether process, filum terminale or other, enables to distinguish neurologic structures (roots or conus medullaris) from non-functional structures (as filum terminale) or other pathologic processes (lipoma, etc.) and preserve the neurologic structures.
A clinical case of a 9 year-old child that carries the disease since birth is presented. She underwent surgery –using a neurophysiologic intrasurgical record– by which symptomatology was partially reverted back.