A Meta-analysis Of The Efficacy And Safety Of Detethering Surgery Used IONM In Patients With TCS

Objective:This study will evaluate the effectiveness of intraoperative neuroelectrophysiological spinal cord thrombolysis from three aspects:sensation,movement and urinary system,and systematically evaluate the safety of multiple neuroelectrophysiological monitoring technology,so as to objectively and comprehensively explain the significance of intraoperative neuromonitoring technology(IONM)in patients with tethered cord syndrome(TCS).Methods:four databases i.e.Pubmed,Embase,CNKI and Wan Fang,were searched by using certain retrieval strategies.The literatures with prognosis information of IONM were searched.The data of sensory,motor and urinary system symptoms were extracted from the random or fixed effect model to combine the improvement rate and deterioration rate and its 95%confidence interval to determine the improvement rate or deterioration rate of clinical symptoms in TCS patients who received the treatment of spinal cord thrombolysis.Results:We included 16 articles from PubMed,EMBASE,CNKI,Wanfang medical network and other literature sources.The total number of patients in 16 articles was 930,and 9 articles were included in the literature about the improvement of postoperative sensory abnormality or pain,motor function and urinary system symptoms.The number of patients in these three aspects were 264?350 and 408 respectively.The three aspects were postoperative symptoms.The improvement rates were 31.0%-93.0%,35.0%-74.0%,42.0%-75.0%respectively,and the consolidation rates were 0.670(I~2=89.5%,P<0.001),0.72(I~2=88.9%,P<0.001),0.61(I~2=31.8%,P<0.001).A total of 435 patients with multiple IONM were enrolled in 9 studies.The deterioration rate of neurological function was 0-10%and the combined rate was 0.03(I~2=53.6%,P=0.028).Conclusion:IONM is a safe and optional auxiliary technique for surgery.The symptoms of pain or sensory abnormality,dyskinesia and urinary system dysfunction can be improved in different degrees.However,any kind of neuroelectrophysiological monitoring method has its own advantages and limitations.The multiple neuroelectrophysiological monitoring technology combined with multiple neuroelectrophysiological monitoring technologies can The functional nerve tissues were differentiated and the integrity information of the functional nerve loop was fed back to the operator through multiple channels,so as to minimize the iatrogenic injury.