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Intraoperative Monitoring in Tethered Cord Surgery

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Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

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Abstract

The tethered cord syndrome is caused by abnormal fixation of the spinal cord with resultant reduction in blood flow leading to impaired oxidative metabolism of the grey matter. Etiologies include embryological derangement, trauma, and surgery. Common symptoms include but are not limited to pain, weakness, loss of sensation, and bowel/bladder dysfunction. Surgical release allows normalization of blood flow and then parallel neurological improvement. Goals of neurosurgery to correct tethered cord are full release of restricted tissue and preservation of involved neural structures. Because of difficulty identifying neural elements based on anatomic appearance, multimodality neurophysiologic monitoring is employed to minimize risk and preserve function, especially bowel and bladder control. A technique using spontaneous and evoked electromyography, somatosensory-evoked potentials, motor-evoked potentials, bulbocavernosus reflex elicitation, and bladder pressure urometry was successfully integrated into the surgical release of this patient’s tethered cord.

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Notes

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Authors and Affiliations

  1. Department of Anesthesiology, University of Colorado School of Medicine, 12401 E 17th Avenue, Aurora, CO, 12401, USA

    Daniel J. Janik M.D. & Claudia F. Clavijo M.D.

Authors
  1. Daniel J. Janik M.D.
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  2. Claudia F. Clavijo M.D.
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Corresponding author

Correspondence to Daniel J. Janik M.D. .

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Editors and Affiliations

  1. Departments of Anesthesiology, Neurological Surgery and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Antoun Koht

  2. Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA

    Tod B. Sloan

  3. Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA

    J. Richard Toleikis

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Janik, D.J., Clavijo, C.F. (2017). Intraoperative Monitoring in Tethered Cord Surgery. In: Koht, A., Sloan, T., Toleikis, J. (eds) Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals. Springer, Cham. https://doi.org/10.1007/978-3-319-46542-5_37

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  • DOI: https://doi.org/10.1007/978-3-319-46542-5_37

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46540-1

  • Online ISBN: 978-3-319-46542-5

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