Spinal lumbar multimodal neurophysiological monitoring in a patient with deep brain Stimulator: A case report

Intraoperative neurophysiological monitoring (IONM) is a highly valuable tool in spinal surgery. It allows for real-time evaluation of nervous system function and alerts the surgeon to any warning signs. Among the various techniques used are motor evoked potentials (MEPs) through transcranial electrical stimulation, which involve applying an electrical stimulus to the scalp in the primary motor cortex region and recording it in the corresponding muscles of the corticospinal tract. There are relative contraindications for this technique, such as in patients who have an implantable device. There is no consensus on how to perform this technique in patients with a deep brain stimulator. We present the case of a 61-year-old patient with Parkinson's disease and a deep brain stimulator (DBS), and who underwent spinal surgery for lumbar discopathy. IONM was performed during the procedure using MEPs, necessitating the deactivation of the DBS to protect its function. Upon completion of the surgical procedure, the device was reactivated, confirming its proper function. We demonstrate that this technique can be safe for these patients, weighing the potential risks and benefits. However, it will be necessary to develop specific guidelines for performing these techniques in the future.