Protection of the remaining spinal cord function with intraoperative neurophysiological monitoring during paraparetic scoliosis surgery: a case report.

OBJECTIVE: To demonstrate the usefulness of rectus femoris muscle MEPs monitoring in a paraparetic neuromuscular scoliosis case.
METHODS: Multiple monitoring modalities including SEPs, MEPs and EMG were performed for an anterior and posterior correction surgery for a neuromuscular scoliosis patient with no motor and sensory function below the knees.
RESULTS: Bilateral tibial nerve SEPs were absent, and no MEPs were recordable from anterior tibialis and abductor hallucis muscles bilaterally at baseline. Robust MEPs were recorded on abductor pollicis brevis and rectus femoris muscles bilaterally. Spinal cord monitoring mainly relied on MEPs from bilateral rectus femoris muscles (RF-MEPs). Twice RF-MEPs were absent following deformity correction and returned after removal of both rods. The patient's remaining spinal cord function was preserved.
CONCLUSIONS: Intraoperative neurophysiological monitoring should be used for neuromuscular scoliosis cases with paraparesis if proximal function, such as the rectus femoris muscle, exists.