Preservation of pelvic organ functions after surgical treatment of tumors in the caudal section of the spinal cord: role of intraoperative neurophysiological monitoring

Abstract

The effectiveness of intraoperative neurophysiological monitoring of the segmental apparatus for the regulation of pelvic functions during surgical treatment of tumors in the caudal spinal cord was assessed. In this study, 99 patients with extramedullary and intramedullary spinal cord tumors at the Th11–S5 vertebral levels who received neurosurgical treatment were examined. Based on the extent of intraoperative neurophysiological monitoring, patients were divided into two groups: group 1 underwent standard monitoring of the pyramidal system, and group 2 underwent extended monitoring of pelvic organ functions, which was based on the recording of the bulbocavernosus reflex. Neurological examinations were conducted for all patients before surgery and in the early postoperative period (10–14 days). Twelve months after the surgery, a telephone survey of the complaints of pelvic organ dysfunction was conducted. The surgical outcomes of both groups were compared. Pelvic organ dysfunctions in the preoperative period were identified in 25%–30% of the patients in each group. In the examination 10–14 days after surgery, pelvic organ dysfunctions were found in 20 (48.8%) patients in group 1 and in 16 (27.6%) in group 2. At 12 months after surgery, the dysfunction rate increased from 56.1% (n = 23) in group 1 to 29.3% (n = 17) in group 2. Non-monitoring increased the risk of pelvic organ dysfunctions by 2.5 times in the early postoperative period (odds ratio, 2.50 (1.07–5.79)) and 3.08 times after 1 year (odds ratio, 3.08 (1.35–7.11)). Monitoring of pelvic functions reduced the risk of pelvic organ dysfunctions first identified in the early postoperative period by 5.2 times (odds ratio, 0.192 (0.04–0.80)). Thus, intraoperative continuous monitoring of the state of the segmental apparatus for regulating pelvic functions helps minimize the risk of postoperative development of pelvic disorders in patients with tumor lesions of the caudal parts of the spinal cord. Pelvic monitoring increases the functional permissibility of the operation, maintaining or improving the quality of life of the patients.