The evaluation of triggered electromyography on neurological function during tethered cord release in children
Objective To evaluate the application value of triggered electromyography(tEMG)in the assessment of neurological function during spinal cord tethering release surgery in children.Methods A retrospective analysis was conducted on the clinical data of 85 children with spinal cord tethering syndrome who were admitted to the Department of Neurosurgery,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University from January 2020 to August 2022 and underwent intraoperative tEMG monitoring.A total of 48 children had neurological dysfunction preoperatively.All 85 patients were subjected to spinal cord tethering release surgery.The stimulation threshold and amplitude of the tEMG eliciting compound muscle action potential(CMAP)in the target muscle,which induced by nerve roots at the lesion site before surgery was documented.The nerve root was tested again immediately after surgery and the difference in tEMG thresholds before surgery and immediately after surgery was analyzed.The preoperative tEMG threshold was used to stimulate the nerve roots immediately after surgery,the difference in CMAP amplitude before and immediately after surgery was analyzed(the tEMG threshold and CMAP amplitude of each patient were the average values obtained when stimulating bilateral nerve roots at the lesion site),and improvement of neurological function in children after surgery was evaluated.Results The surgeries were successfully completed in all 85 children.Postoperative pathology confirmed 43 cases of spinal lipoma,8 cases of lipomyomeningocele,6 cases of myelomeningocele,and 28 cases of secondary tethered cord syndrome.There were no postoperative complications such as cerebrospinal fluid leakage and incision infection.Neurological dysfunction improved in 70.8％(34/48)of the children after surgery.Compared with preoperatively,the tEMG threshold[M(Q1,Q3)]of the nerve root in the lesion site of the child decreased significantly immediately after surgery,and the difference was statistically significant[preoperative:3.40(1.60,5.00)mA,immediately after surgery:2.10(1.50,3.50)mA,Z=5.89,P＜0.001)].In 31 cases of spinal lipoma,8 cases of lipomyelomeningocele,5 cases of myelomeningocele and 17 cases of secondary tethered cord syndrome,the tEMG thresholds in the immediate postoperative period were significantly lower than those before surgery,and the differences were statistically significant(all P＜0.05).With the tEMG threshold before tethered cord release surgery was being used to stimulate the nerve roots immediately after surgery,the CMAP amplitude[M(Q1,Q3)]of the nerve roots elicited immediately after surgery increased significantly compared with before surgery,and the difference was statistically significant[preoperative:8.40(5.00,17.50)μV,immediately after surgery:17.50(8.15,26.78)μV,Z=-6.20,P＜0.001].Among them,the CMAP amplitude of 36 children with spinal lipoma,6 children with myelomeningocele,and 18 children with secondary tethered cord syndrome increased significantly immediately after surgery compared with that before surgery,and the differences were all statistically significant(all P＜0.05),while the amplitude of CMAP did not change significantly before and immediately after surgery in 8 children with lipomyelomeningocele(P=0.192).Conclusions Intraoperative tEMG can not only help monitor and protect the neurological function of children,but also indicate the improvement of neurological function.It has good application value.
Monitoring,intraoperativeChildTriggered electromyographyTethered cord syndromeSpinal cord tether release surgery
万方数据
维普
