Importance of Intraoperative Neuromonitoring in Simultaneous Release of Tethered Cord and Corrective Surgery for Severe Kyphoscoliosis Deformity: A Case Report

Background Data: Kyphoscoliosis in conjunction with tethered cord is a rare and challenging spinal deformity to treat. The availability of intraoperative monitoring in recent times has helped reduce the incidence of operative neurological complications in spine deformity corrective surgery. The present case report underlines the value and utility of intraoperative neuromonitoring in corrective surgery for kyphoscoliosis. Study Design: Case report. Purpose: To report the importance of intraoperative neuromonitoring in the release of tethered cord along with deformity correction. Case Report: A 14-year-old male patient presented with a one-month history of progressive weakness in both lower extremities. Radiographs showed that he had thoracic kyphoscoliosis with a 30-degree scoliotic curve together with a 70-degree kyphotic curve with an apical vertebra of T12. The preoperative MRI and CT showed that the spinal cord was entrapped by the apical vertebra and a butterfly vertebra was noted at T12. This resulted in the right half being smaller in size, with the resultant convexity to the left side. The conus was low-lying and tethered at the L3 level. The patient underwent detethering of the cord with corrective surgery for kyphoscoliosis in the same setting under intraoperative neuromonitoring. Results: Scoliosis was corrected to 20 degrees and kyphosis was corrected to 40 degrees. The motor evoked potentials (MEPs) that previously showed very feeble tracings now showed persistent positive potentials. The SSEPs remained constant and the same as baseline throughout. The patient’s spinal cord function improved from Frankel C to Frankel D. A good trunk balance was evident at the two-month follow-up. Conclusion: Intraoperative neuromonitoring allowed safe and effective detethering and maintained correction of the kyphoscoliosis. (2021ESJ234)