SSEP/TCS for

[Guest guest]

Like all tests...

1) They are operator dependent

2) Results can be interpreted differently by different individuals (I.e. if your

NS didn't think tsc was an issue you might look at them differently)

HAving said this, in your situation, although you might have a radiculopathy,

you can still have TSC (like me, I presented with radiculopathies but also had

tsc). SO, if the SSEP was adding information, good...if it is normal, it does

NOT rule out tsc.

Good luck

How are you doing?

Here's an article

1: Surg Neurol.<javascript:AL_get(this,%20'jour',%20'Surg%20Neurol.');> 1986

Sep;26(3):241-8. Links<javascript:PopUpMenu2_Set(Menu3738717);>

Evaluation of children and young adults with tethered spinal cord syndrome.

Utility of spinal and scalp recorded somatosensory evoked potentials.

a.. Roy

MW<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & itool=pubm\

ed_AbstractPlus & term=%22Roy+MW%22%5BAuthor%5D>,

b.. Gilmore

R<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & itool=pubme\

d_AbstractPlus & term=%22Gilmore+R%22%5BAuthor%5D>,

c.. Walsh

JW<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & itool=pubm\

ed_AbstractPlus & term=%22Walsh+JW%22%5BAuthor%5D>.

The diagnosis of tethered spinal cord syndrome should be considered in young

patients with progressive orthopedic deformities, lower extremity weakness,

urinary and fecal incontinence, low back pain, or combinations of these

symptoms. Myelographic, computed tomographic, and urodynamic studies are useful

for establishing a diagnosis, but contribute little to the evaluation of lower

extremity sensory function or to the assessment of electrophysiologic impairment

of the spinal cord itself. To determine the diagnostic usefulness of the

somatosensory evoked potential after posterior tibial nerve stimulation

(posterior tibial nerve somatosensory evoked potential) in tethered spinal cord

syndrome, 22 consecutive patients with symptoms of tethered spinal cord syndrome

(aged 18 months to 22 years) underwent recording of posterior tibial nerve

somatosensory evoked potential; results were correlated with clinical,

myelographic, and operative findings. In patients with clinical symptoms but no

myelographically demonstrable lesions, posterior tibial nerve somatosensory

evoked potentials were within normal limits, suggesting normal physiologic

function. In patients with myelographically and operatively confirmed tethering

dysraphic lesions, posterior tibial nerve somatosensory evoked potential was

predictive of the level and laterality of the lesion. Similarly, ranking the

severity of neurological impairment and extent of dysraphism at operation, as

well as the extent of abnormality of posterior tibial nerve somatosensory evoked

potential, revealed a significant (r = 0.81, p less than 0.001) correlation

between clinical severity and posterior tibial nerve somatosensory evoked

potential abnormalities. Postoperatively, in 8 patients, posterior tibial nerve

somatosensory evoked potential also reflected improved function in relation to

the level and type of dysraphic lesion present. These findings indicate that

posterior tibial nerve somatosensory evoked potential is a sensitive indicator

of neurophysiologic status in patients with tethered spinal cord, and is useful

for determining the level of the conus medullaris, degree of spinal cord

displacement, and severity of neurological impairment associated with this

congenital disturbance of neuraxis formation. Recording of posterior tibial

nerve somatosensory evoked potential is noninvasive and offers a more sensitive

diagnostic tool than the clinical testing of sensation for detection of the

development of neurologic deficits in patients with tethered cord syndrome.

PMID: 3738717 [PubMed - indexed for MEDLINE]

Re: Re: Tethered Cord and EMG's

hmmmm........interesting. Are you aware of any medical references

surrounding this?

I wonder if this holds true in regards to(when an EMG is done after Surgery)

damage done by the Surgery itself, which can be the same type that Tethered

Cord can do itself, without Surgery?

I had an EMG about a Month or so after my last Detethering (because of the

Complications). I fought it, Dr. was, well, less than par.....and if I

remember correctly it was stopped early. Now I wonder, even more so, if that

was even useful or wise to have done?!? The results it did provide were

abnormal.

Me

Nebraska, USA

mymocha@...

I'm not sure how many in the group are aware that an EMG tests just

the peripheral nerves. My doc used the EMG as a dignostic tool to

help determine surgery. If your EMG comes back normal yet you have

decreased sensation or muscle tone it indicates that the issues is

with the central nervous system (spine or brain)supporting a Dx of

tethered cord. If my EMG had come back abnormal I would not have been

detethered because the test would have indicated the problem was not

in the spine. The unfortunate thing is it does not do much to help

determine where the central issue is. Sometimes the lack of signal

return from the cord can inidcate the level of tethering but the doc

who did mine said it doesn't happen that way very often. If your doc

uses a normal EMG reading to say you do not have tethered cord be

wary. I'm not saying that is the case for Kathy but I have heard it

from other people before so wanted to post the info.

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