“Safety” is the key word in spine surgery
21 May 2019
Specialists from the Carolina Medical Center performed a surgery of cutting filum terminale of spinal cord with tethered spinal cord syndrome. The surgery was assisted by intraoperative neuromonitoring. The use of neuromonitoring is intended to increase patient’s safety when working on the spinal cord.
Tethered spinal cord syndrome is usually observed in youngsters but also in adults. It occurs when filum terminale (end thread of spinal cord) is thickened and the location of the cone of the spinal cord is below the correct level. Symptoms may also appear in people whose cauda equine (Latin for “horse’e tail”) is normally positioned, then the reason for tethered spinal cord syndrome is only the thickening of the filum terminale, which is infiltrated with adipose tissue.
Tethered spinal cord syndrome is a developmental defect, and clinical symptoms may be the result of long-term flexion and straightening of the spine, which leads to micro traumas of the spinal cord and nerve roots. Symptoms may increase as a result of doing sports. The disease is progressive. The initial sign of the disease is pain, which intensifies when bending down. Over time, numbness, lower back pain, paresis, difficulty in maintaining urine, and sphincter dysfunction may occur.
The procedure for releasing a tethered core involves cutting filum terminale or other structures that bind the spinal cord to the core. During the procedure it is necessary to carry out laminectomy and to find filum terminale among the nerve fibers. Throughout this surgery there is a risk of neurological complications, which is why it is performed in the presence of intraoperative neuromonitoring.
The patient is connected to special receiving and stimulating electrodes that inform the surgeon about sensitive nerve structures during surgery. This is very important especially when the patient is asleep and there is no contact with him. The procedure is also attended by a neurophysiologist who monitors the patient's condition on an ongoing basis. As a result, surgeons are able to change the surgical technique at any time, without the risk of damaging sensitive nerve structures. A few years ago, there was no such possibility of monitoring, which was associated with a higher risk of postoperative complications - emphasizes Jurij Kseniuk, a specialist in spinal surgery in Carolina Medical Center.
Neuromonitoring is used during surgical procedures in which there is a risk of damage to nerve structures. Irritation of these structures can lead to serious postoperative complications. Owing to neuromonitoring, the surgeon can check at any time how the nerve is positioned in the operating field and determine whether the tissue contains sensitive nerve structures. Electrodes attached to the patient generate and receive signals. During the procedure, a neurophysiologist actively interprets the results appearing on the monitor. He pays attention to any change in amplitude (decreased and increased potentials) and to extended or shortened time of the response from a given tissue.
Neuromonitoring in spinal surgery fulfills one more role. It allows to perform fewer X-ray images which are necessary to check the correctness of the implants position. As a result, the patient and the entire team at the operating theater are less exposed to the effects of X-rays.