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Scoliosis Corrective Surgery With Continuous Intraoperative Neurophysiological Monitoring (IONM).

Faisal R Jahangiri1,2,3,4, Rafia H Jahangiri5,3, Hooria Asad5,3

  • 1Intraoperative Neuromonitoring Program, Labouré College of Healthcare, Milton, USA.

Cureus
|November 16, 2022
PubMed
Summary

Intraoperative neurophysiological monitoring (IONM) detected nerve compromise during scoliosis surgery, allowing immediate intervention. This multimodal approach, including motor evoked potentials, is crucial for preventing neurological deficits in spinal correction procedures.

Keywords:
ionmneuromonitoringneurophysiologyorthopedicpediatricsscoliosisspinesurgery

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Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Neuromonitoring

Background:

  • Scoliosis correction surgery involves pedicle screw placement and traction, risking neurological injury.
  • Spinal cord functional compromise can occur from correction weight, leading to paresis or paralysis.

Observation:

  • A 10-year-old female with severe scoliosis (120° Cobb angle) underwent surgery with multimodal intraoperative neurophysiological monitoring (IONM).
  • Transcranial electrical motor evoked potential (TCeMEP) changes in lower extremities were detected after pedicle screw placement.
  • Somatosensory evoked potential (SSEP) changes in the left arm were observed upon repositioning.

Findings:

  • Immediate TCeMEP changes prompted a reduction in traction weight and increased blood pressure, restoring baseline responses.
  • SSEP changes resolved with arm repositioning, indicating successful management of nerve irritation.

Implications:

  • Multimodal IONM effectively monitors sensory and motor spinal cord functions during scoliosis surgery.
  • Timely detection and reversal of nerve injuries using IONM can minimize postoperative neurological deficits.
  • Routine use of multimodal IONM is recommended for scoliosis correction procedures.