F Pastorelli1,2, M Di Silvestre3, F Vommaro3, E Maredi3, A Morigi4, M R Bacchin4, S Bonarelli4, R Plasmati5, R Michelucci5, T Greggi3. 1. Neurophysiology Serv., Rizzoli Orthopedic Institute, Bologna, Italy. francesca182@gmail.com. 2. Department Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche, Via Altura 3, 40139, Bologna, Italy. francesca182@gmail.com. 3. Spinal Deformity Surgery Department, Rizzoli Orthopaedic Institute, Bologna, Italy. 4. Anesthesiology Department, Rizzoli Orthopaedic Institute, Bologna, Italy. 5. Department Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche, Via Altura 3, 40139, Bologna, Italy.
Abstract
PURPOSE: Combined intraoperative monitoring (IOM) of transcranial electric motor-evoked potentials (tce-MEPs) and somatosensory-evoked potentials (SSEPs) is safe and effective for spinal cord monitoring during scoliosis surgery. However, the literature data regarding the reliability of spinal cord monitoring in patients with neuromuscular scoliosis are conflicting and need to be confirmed. METHODS: We reviewed IOM records of 40 consecutive patients with neuromuscular scoliosis related to central nervous system (CNS) (29 pts) or peripheral nervous system (PNS) (11 patients) diseases, who underwent posterior fusion with instrumentation surgery for spinal deformity. Multimodalitary IOM with SSEPs and tce-MEPs was performed. RESULTS: Spinal cord monitoring using at least one modality was attempted in 38/40 (95 %) patients. No false-negative results were present in either group, but a relatively high incidence of false-positive cases (4/29, 13.8 %) was noted in the CNS group. Two patients in the CNS group and one patient in the PNS group presented transient postoperative motor deficits (true positive), related to surgical manoeuvres in two cases and to malposition in the other one. CONCLUSIONS: Multimodalitary IOM is safe and effective to detect impending spinal cord and peripheral nerves dysfunction in neuromuscular scoliosis surgery. However, the interpretation of neurophysiological data may be challenging in such patients, and the rate of false-positive results is high when pre-operatory motor deficits are severe.
PURPOSE: Combined intraoperative monitoring (IOM) of transcranial electric motor-evoked potentials (tce-MEPs) and somatosensory-evoked potentials (SSEPs) is safe and effective for spinal cord monitoring during scoliosis surgery. However, the literature data regarding the reliability of spinal cord monitoring in patients with neuromuscular scoliosis are conflicting and need to be confirmed. METHODS: We reviewed IOM records of 40 consecutive patients with neuromuscular scoliosis related to central nervous system (CNS) (29 pts) or peripheral nervous system (PNS) (11 patients) diseases, who underwent posterior fusion with instrumentation surgery for spinal deformity. Multimodalitary IOM with SSEPs and tce-MEPs was performed. RESULTS: Spinal cord monitoring using at least one modality was attempted in 38/40 (95 %) patients. No false-negative results were present in either group, but a relatively high incidence of false-positive cases (4/29, 13.8 %) was noted in the CNS group. Two patients in the CNS group and one patient in the PNS group presented transient postoperative motor deficits (true positive), related to surgical manoeuvres in two cases and to malposition in the other one. CONCLUSIONS: Multimodalitary IOM is safe and effective to detect impending spinal cord and peripheral nerves dysfunction in neuromuscular scoliosis surgery. However, the interpretation of neurophysiological data may be challenging in such patients, and the rate of false-positive results is high when pre-operatory motor deficits are severe.
Authors: T J Wilson-Holden; A M Padberg; L G Lenke; B J Larson; K H Bridwell; G S Bassett Journal: Spine (Phila Pa 1976) Date: 1999-08-15 Impact factor: 3.468
Authors: F Pastorelli; M Di Silvestre; R Plasmati; R Michelucci; T Greggi; A Morigi; M R Bacchin; S Bonarelli; A Cioni; F Vommaro; N Fini; F Lolli; P Parisini Journal: Eur Spine J Date: 2011-03-18 Impact factor: 3.134
Authors: Barry L Raynor; Joseph D Bright; Lawrence G Lenke; Raʼkerry K Rahman; Keith H Bridwell; K Daniel Riew; Jacob M Buchowski; Scott J Luhmann; Anne M Padberg Journal: Spine (Phila Pa 1976) Date: 2013-01-15 Impact factor: 3.468
Authors: Akash J Patel; Satish Agadi; Jonathan G Thomas; Robert J Schmidt; Steven W Hwang; Daniel H Fulkerson; Chris D Glover; Andrew Jea Journal: Childs Nerv Syst Date: 2012-10-23 Impact factor: 1.475