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The Value of Intraoperative Neurophysiological Monitoring During Patient Positioning in Spine Surgery: A Preventive
Paula Rebelo1, Cristina P Sousa2, Manuel T Campos3
1Anesthesiology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, PRT.
Cureus
|December 16, 2024
Summary
Anesthetic management for cervical spine surgery in myelopathy patients requires vigilance beyond intubation. Multimodal intraoperative neurophysiological monitoring is crucial for preventing secondary spinal cord injury and improving outcomes.
Area of Science:
- Neurosurgery
- Anesthesiology
- Neurophysiology
Background:
- Cervical spine surgery in myelopathy patients presents significant anesthetic challenges due to the risk of secondary spinal cord injury (SCI).
- Traditional concerns focus on intubation-related cervical movement, but other factors like patient positioning and spinal perfusion pressure are critical.
- Multimodal intraoperative neurophysiological monitoring (IONM), including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), aids real-time spinal cord integrity assessment.
Observation:
- A 73-year-old male with cervical spondylotic myelopathy and C6 neurological deficits underwent anterior cervical discectomy and fusion.
- Anesthesia involved awake fiberoptic intubation, propofol-remifentanil infusions (no muscle relaxants), and comprehensive IONM including EEG, cerebral oximetry (NIRS), and nociception monitoring (ANI®).
- Monitoring began pre-positioning; a transient hypotensive episode was managed, and surgery proceeded without neurological deterioration.
Findings:
- The patient experienced no additional neurological deficits post-operatively and recovered normal muscle strength at three months.
- Cervical myelopathy increases spinal cord sensitivity, necessitating heightened anesthetic vigilance.
- IONM, initiated before critical surgical phases like positioning, is vital for detecting neural compromise.
Implications:
- Anesthetic management must extend beyond intubation to encompass patient positioning and spinal perfusion.
- Proactive IONM is essential for preventing secondary SCI in cervical myelopathy surgery.
- This approach improves patient outcomes by enabling early intervention during surgery.
