Introduction
Material and methods
Subjects
n
| % | |
---|---|---|
Number of patients (n, % male) | 65 | 37 |
Age (mean 22.0 years, SD 22.4 years) | – | – |
Diagnoses (n, % of total) | ||
▪ High-risk group: lipomyelomeningocele (LMC)/split cord malformation (SCM) + tight filum terminale (TFT) | 40 | 62 |
▪ Tight filum terminale (TFT) | 10 | 15 |
▪ Myelomeningocele (MMC) | 2 | 3.1 |
▪ Dermoid sinus | 5 | 7.7 |
▪ Tight filum terminale (TFT) + filum lipoma | 3 | 4.6 |
▪ Other | 5 | 7.7 |
Symptomatic patients (n = 50) | Sole symptom, n
| Total, n
a
|
---|---|---|
Neurological deficits | 2 | 32 |
Urological deficits | 4 | 27 |
Orthopedic deficits | 7 | 14 |
Pain | 3 | 28 |
Methods
IONM procedure
Anesthetics
Scoring
Deficit | Neurological | Urological | Orthopedic | Pain |
---|---|---|---|---|
0 = none | – | – | – | – |
1 = minimal | Sensibility | VU abnormal | Scoliosis minimal | Pain minimal |
2 = moderate | Motor minimal (>4) | Bladder residue | Scoliosis moderate | Pain moderate |
3 = severe | Motor paresis (<4) | Incontinence | Scoliosis severe | Pain severe |
Results
Feasibility
Safety
Deficits | Improved | Stable | Deteriorated |
---|---|---|---|
Neurological | 4 | 60 | 1a
|
Urological | 1 | 63 | 1a
|
Pain | 20 | 44 | 1 |
Score difference | Neurologic, n
| Urologic, n
| Pain, N
| |
---|---|---|---|---|
Improved | +1 | 3 | 1 | 14 |
+2 | 1 | – | 5 | |
+3 | – | – | 1 | |
Subtotal | 4 | 1 | 20 | |
Stable | 60 | 63 | 44 | |
Deteriorated | −1 | 1 | – | 1 |
−2 | – | – | – | |
−3 | – | 1 | – | |
Subtotal | 1 | 1 | 1 |
High-risk group
HRG (n = 40) | nHRG (n = 25) | |||
---|---|---|---|---|
Scoring deficits |
n
| % |
n
| % |
Neurological | ||||
Improved | 3 | 7.5 | 1 | 4.0 |
Stable | 37 | 93 | 23 | 92 |
Deteriorated | 0 | 0.0 | 1 | 4.0 |
Urological | ||||
Improved | 0 | 0.0 | 1 | 4.0 |
Stable | 40 | 100 | 23 | 92 |
Deteriorated | 0 | 0.0 | 1 | 4.0 |
Pain | ||||
Improved | 12 | 30 | 8 | 32 |
Stable | 27 | 68 | 17 | 68 |
Deteriorated | 1 | 2.5 | 0 | 0.0 |
Non-high-risk group
Prophylactic patients
Follow-up
Score difference | Neurological, n (%) | Urological, n (%) | Orthopedic, n (%) | Pain, N (%) | |
---|---|---|---|---|---|
Improved | +1 | 3 | 4 | 1 | 1 |
+2 | 1 | 1 | – | – | |
+3 | – | 1 | – | 1 | |
Subtotal | 4 (6.2) | 6 (9.2) | 1 (1.5) | 2 (3.1) | |
Stable | 60 (92) | 57 (88) | 61 (94) | 63 (97) | |
Deteriorated | −1 | 1 | 1 | 3 | – |
−2 | – | – | – | – | |
−3 | – | 1 | – | – | |
Subtotal | 1 (1.5) | 2 (3.1) | 3 (4.6) | 0 (0.0) |
Follow-up HRG
HRG (n = 40) | nHRG (n = 25) | |||
---|---|---|---|---|
n
| % |
n
| % | |
Neurological | ||||
Improved | 3 | 7.5 | 1 | 4.0 |
Stable | 37 | 93 | 23 | 92 |
Deteriorated | 0 | 0.0 | 1 | 4.0 |
Urological | ||||
Improved | 4 | 10 | 2 | 8.0 |
Stable | 35 | 88 | 22 | 88 |
Deteriorated | 1 | 2.5 | 1 | 4.0 |
Orthopedic | ||||
Improved | 1 | 2.5 | 0 | 0.0 |
Stable | 36 | 90 | 25 | 100 |
Deteriorated | 3 | 7.5 | 0 | 0.0 |
Pain | ||||
Improved | 2 | 5.0 | 0 | 0.0 |
Stable | 38 | 95 | 25 | 100 |
Deteriorated | 0 | 0.0 | 0 | 0.0 |
Follow-up nHRG
Follow-up prophylactic group
Discussion
Feasibility
Safety
Follow-up
Conclusions
-
IONM is technically feasible in all our patients. Concerning safety, there was a stable or improved neurological score in 64 out of 65 patients. No neurological or urological deterioration occurred in our HRG (n = 40), while the follow-up of this group showed stable or improved neurology scores.
-
Standard use of IONM should be considered in TCS surgery in order to improve safety.
-
A potential positive effect of IONM on the efficacy of surgery might be present.