Objective To explore the application value of intraoperative neurophysiological monitoring in the surgery of spinal cord untethering.Methods A total of 35 patients with tethered cord syndrome admitted to Department of Neurosurgery,Yuquan Hospital,Tsinghua University from June 2014 to December 2016 were electrophysiologically monitored in terms of somatosensory evoked potentials (SEP) and electromyogram(EMG) during operation.The Hoffman scale was adopted to evaluate nerve function in all patients.The changes of electrophysiological parameters and the nerve functions were analyzed.The relationship between SEP monitoring results and Hoffman scale was investigated.Results Among 35 patients,the cortical potential P40 was recorded in 29 cases.There were continuous bursts of large myoelectric response in 21 patients during operation.All patients underwent nerve root stimulation to identify the cauda equina and iilum terminale,the latter were then cut.The follow-up period lasted 6-13 months with an average of 9.4 ± 5.8 months.Significant improvement of neurological function was reported in 8 patients,fair improvement in 18,and no improvement in 9 cases.Comparative analysis showed that in the patients with significant improvement,postoperative amplitude and latency were significant different from preoperative results (both P ＜ 0.05).In the patients with fair improvement,the latency rather than amplitude was significantly different (P ＜ 0.05) comparing pre-and postoperative data.In the patients with no change,there was no significant difference in the latency or amplitude post operation (both P ＞ 0.05).Conclusion Employed in the surgery of spinal cord untethering in children,intraoperative electrophysiological monitoring could effectively help avoid nerve damage,reduce the occurrence of postoperative complications,and improve the clinical outcomes.

Objective Deep brain stimulation (DBS) can greatly improve the clinical symptoms of Parkinson's disease (PD),but it can poorly improve the similar clinical symptoms of multiple system atrophy P-type (MSA-P);therefore,identification is a necessity for the two diseases before DBS is carried out on these patients;surface electromyography (sEMG) was employed to analyze the surface electromyographic characteristics associated with tremor and rigidity of PD and MSA-P to explore the role of sEMG in the differential diagnosis of PD and MSA-P.Methods Twenty patients with PD and 25 patients with MSA-P,admitted to our hospital from June 2013 to January 2015,were enrolled in the study.The sEMG was performed on all patients on the 2nd d of hospitalization.Tremor frequency,tremor sEMG activity intensity and postural tremor latency were analyzed.Synchronous sEMG activity intensity during passive activities was analyzed.Root mean square (RMS) in two states was calculated,and t-test was applied to compare tremor frequency,postural tremor latency and sEMG activity intensity.Results The incidence of rest tremor in MSA-P patients was 36％ and that in PD patients was 60％,with significant difference (P＜0.05).And the incidence ofpostural tremor in MSA-P ones was 44％ and that in PD ones was 35％,with significant difference (P＜0.05).Besides,the postural tremor latency in MSA-P patients was significantly longer than that in PD patients ([9.3±3.2] s vs.[5.3±2.1] s,P＜0.05).Thepostural tremor and rest tremor frequencies of MSA-P patients ([7.3±2.1] and [6.4±3.6]-Hz) were significantly higher than those in PD patients ([5.3±2.4] and [4.9±1.2] Hz,P＜0.05).In rest tremor,RMS of flexor and extensor in MSA-P patients was significantly decreased as compared with that in PD patients (P＜0.05);in postural tremor,RMS of flexor and extensor in MSA-P patients was significantly decreased as compared with that in PD patients (P＜0.05).During passive activities,RMS of extensor in MSA-P patients was statistically higher than that in PD patients ([27.927.9± 11.4] vs.[18.318.3±6.4] μV,P＜0.05),while there was no significant difference between RMS of flexor in MSA-P and PD patients ([31.1±13.6] vs.[29.2±8.9] μV,P＞0.05).Conclusion The sEMG can be applied in the preoperative differential diagnosis for DBS of PD and MSAP.

Objective To analyze surface electromyography activities of spastic cerebral palsy,to explore the role of surface electromyography (sEMG) in evaluation effectiveness of peripheral nerve surgery.Methods Peripheral nerve surgery was carried out in 218 cases,including 171 selective peripheral neurotomy (SPN) and 47 selective posterior rhizotomy (SPR).The sEMG of patients was recorded before and after operations while passive and voluntary movements were performed during recording.The root mean square (RMS) were calculated by time domain analysis.Analysis of Variance was applied to compare RMS before and after operations.Modified Asworth Scale was emplvyed to estimated the patients' muscle tension.And Manual Muscle Testing was applied to assessed patients' muscle strength.Investigate the correlation among MAS,MMT and RMS.Results Two hundred and three cases were followed up for 22 to 30 months (mean 25.6 months).15 cases were lost.Among them,the cases were followed up with 350 sides of adductor,197 sides of quadriceps and 374 sides of triceps.In passive movements,the RMS of adductors,quadriceps and triceps post-surgery were significantly decreased comparing to values of pre-surgery (all P ＜0.05).And those values follow-up were significantly decreased than pre-surgery (all P ＜ 0.05).In voluntary movements,the RMS of quadriceps post-surgery were significantly decreased than pre-surgery (all P ＜ 0.05).However,no significant differences were observed in adductors and triceps between post-surgery and pre-surgery(all P ＞0.05).And there were no significant differences of adductors,quadriceps and triceps observed in follow-up and post-surgery (all P ＞0.05).A higher remission rate (91％) of adductor spasm was observed in 318 postoperative cases of 350 cases,and 98％ (343/350) was observed during follow-up.The quadriceps spasm relief rate was 82％ (161/197) postoperative and 95％ (187/197) during follow-up.Besides the relief rate of triceps spasm was 93％ (348/374) postoperative and 99％ (370/374) during the follow-up.The muscle strength of adductor was reduced by 9％ (31/350) postoperative,while it was increased by 23％ (80/350) during follow-up.Moreover,there was a 21％ (41/197) reduced rate of muscle strength of quadriceps,however,it was increased by 19％ (37/197)during follow-up.The muscle strength of triceps was reduced by 18％ (67/374) postoperative,but it was increased by 29％ (108/374) follow-up.There are significant correlations between MAS,MMT and RMS(both P ＜ 0.05).Conclusions sEMG can objectively evaluate the clinical effectiveness of spastic cerebral palsy as a non-invasive method.Muscle tension is obviously reduced after peripheral nerve surgery carried on spastic cerebral palsy,meanwhile the muscle strength is not significantly decreased.