[Intraoperative neurophysiological monitoring in children undergoing tethered cord surgery].

Objective: To retrospectively explore the multimodal intraoperative monitoring (IOM) technique during untethering cord procedures in 37 patients between 1 month and 16 years of age with tethered cord syndrome during 2014.
Methods: All patients were diagnosed as tethered cord syndrome by clinical manifestations and verified by magnetic resonance imaging (MRI). Free and trigger electromyogram (EMG) and transcranial motor-evoked potentials (tcMEP) of extremity muscles and anal sphincters were used to map the nerves and monitor the functional motor integrity continuously.
Results: The monitorability rate was 100 % for nervous mapping, 86.5% (32/37) for extremity muscle tcMEP. In all patients, tcMEP remained stable during surgery, 43.8% (14/32) patients showed a significant postoperative increase of amplitude of tcMEP, none of them patients presented a significant and yet transient neurological worsening.
Conclusion: The combined technique of monitoring and mapping may boost the procedural safety, minimize the long-term morbidity and improve the clinical outcomes.