Tethered Cord Reke==

Tethered Cord Release

Tethered spinal cord is an abnormal attachment of the spinal cord to tissue around it. A tethered cord release is a procedure to separate the spinal cord from tissue that holds it in place. Causes stretch-induced damage resulting in decreased oxidative metabolism of the lower spinal cord it usually manifests in children with motor, sensory, and sphincter abnormalities. Surgery to "untether" is suggested to avoid future deterioration

Asymptomatic

Surgical Issues

Often performed under an operating microscope as the nerve roots are dissected from the tetherThe complications that may arise due to the surgery are: • Worsening motor/sensory/sphincter • Function • Retethering • CSF leak, meningitis

• Dorsal cuteaneous abnormalities of the lumbosacral region
• Congential malformation with known association to tethered cord
• Incidnetal finding on radiograph obtained for other diagnostic purpose

Symptomatic

• Pain
• Back/lower back extremity/perineal
• Orthopedic deforminty
• Scoliosis
• Foot/leg deformity
• Neurologic dysfunction
• Sensory
• Motor
• Autonomic bowel/bladder

IONM

IONM is utlised in these surguries due to the closes surgical contact with the nerve roots, there can be damaged caused therefore using IONM reduces the risk of surgical complications. EMG monitoring is used for the lower limbs and sphicter to ensure there is no nerve root activity. And SSEP/TcMEPs are used to ensure the integrity of the spinal cord.