研究目的:成人脊髓拴系综合征(Tethered Cord Syndrome，TCS)较儿童脊髓 拴系综合征少见。术中神经电生理监测技术(Intraoperative Neurophysiological Monitoring，IONM)在成人脊髓拴系综合征手术中的作用尚不明确。本研究旨在评 估术中神经电生理监测技术在成人脊髓拴系综合征手术治疗中的应用价值，并重点 探讨经颅运动诱发电位(Transcranial Motor-Evoked Potentials，TcMEPs)对术 后肌力改善的预测价值。

研究方法:本研究为临床回顾性研究，纳入了 2018 年 1 月 1 日至 2024 年 11 月 30 日期间在北京协和医院神经外科接受手术治疗的 122 例成人脊髓拴系综合征患 者。本研究回顾性地收集了患者的性别、年龄、术前神经功能状态、病理结果、影 像资料、随访时间及临床预后等数据。根据手术中是否使用了 IONM 技术，将 122 名患者分为 IONM 组(n = 72)和非 IONM 组(n = 50)以评估 IONM 技术的临床应 用价值。在 IONM 组中，将术前存在肌力下降的患者根据术中 TcMEPs 波幅增加是否 ≥50%进一步分为 TcMEPs≥50%组(n = 18)与 TcMEPs<50%组(n = 24)，并进行亚 组分析。

研究结果:与非 IONM 组相比，IONM 组在术后短期改善率(72.2% vs. 52.0%， p = 0.022)、长期改善率(87.5% vs. 66.0%，p = 0.004)及长期显著改善率(62.5% vs. 42.0%，p = 0.025)方面均显著更高。在术前存在肌力下降的患者中，术中 TcMEPs 波幅增加≥50%的患者，其术后肌力长期改善率显著高于术中 TcMEPs 波幅增加<50% 患者(83.3% vs. 29.2%，p < 0.001)。

结论:术中神经电生理监测技术可显著提升成人脊髓拴系综合征手术的短期及 长期临床疗效。对于肌力下降的患者，术中 TcMEPs 波幅增加≥50%可能是预测术后 肌力能获得长期改善的可靠指标。

Objective: Adult tethered cord syndrome (TCS) is less common than children tethered cord syndrome. The role of intraoperative neurophysiological monitoring (IONM) in adult tethered cord syndrome surgery remains unclear. This study aims to evaluate the clinical value of IONM in the surgical treatment of adult TCS and to investigate the predictive significance of intraoperative transcranial motor-evoked potentials (TcMEPs) for postoperative motor function improvement.

Methods: This was a retrospective clinical study. A total of 122 adult patients with TCS who underwent surgical treatment at the Department of Neurosurgery, Peking Union Medical College Hospital, between January 1, 2018, and November 30, 2024, were included. Data collected included sex, age, preoperative neurological status, pathological results, radiological findings, follow-up duration, and clinical outcomes. Based on the use of IONM techniques during surgery, patients were divided into the IONM group (n = 72) and the non-IONM group (n = 50) to assess the clinical utility of IONM. In the IONM group, patients with preoperative motor weakness were further categorized into two subgroups based on whether intraoperative TcMEPs amplitude increased by ≥50%: the TcMEPs ≥50% group (n = 18) and the TcMEPs <50% group (n = 24), and subgroup analyses were conducted to investigate the predictive value of TcMEPs for muscle strength recovery.

Results: Compared to the non-IONM group, the IONM group demonstrated significantly higher rates of short-term improvement (72.2% vs. 52.0%, p = 0.022), long-term improvement (87.5% vs. 66.0%, p = 0.004), and long-term significant improvement (62.5% vs. 42.0%, p = 0.025). Among patients with preoperative muscle weakness, those with a ≥ 50% increase in TcMEPs amplitude showed a significantly higher rate of long-term muscle strength improvement (83.3% vs. 29.2%, p < 0.001).

Conclusions: Intraoperative neurophysiological monitoring significantly enhances 2both short-term and long-term surgical outcomes in adult TCS. For patients with muscle weakness, an intraoperative TcMEPs amplitude increase of ≥50% may serve as a reliable predictor of long-term postoperative motor function recovery.