Justin Tilan1, Lindsay M Andras2, Mark D Krieger3, David L Skaggs4. 1. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 2. Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA. 3. Department of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 4. Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA. dskaggs@chla.usc.edu.
Abstract
PURPOSE: To present a case of loss of motor-evoked potentials (MEPs) to the left foot in the supine position after a partial reduction and instrumented fusion from L4 to pelvis which was managed successfully without revision or removal of implants. METHODS: We report a patient with high-grade spondylolisthesis who demonstrated loss of motor-evoked potentials after posterior spinal fusion and transfer to supine position. The patient's knees were flexed to 90° and signals were immediately restored. Systemic steroids were administered and circumferential fusion was delayed 21 days. Anterior-interbody cage was placed without complication. RESULTS: She was discharged on post-operative day 2. At 7 months, she is pain free and doing well with plans to return to gymnastics completely. CONCLUSIONS: Knee flexion can be instituted when encountering a neuromonitoring signal change following posterior spinal fusion for spondylolisthesis as a means to alleviate acute nerve stretch injury and may in some cases prevent the need to lessen the correction. LEVEL OF EVIDENCE: IV.
PURPOSE: To present a case of loss of motor-evoked potentials (MEPs) to the left foot in the supine position after a partial reduction and instrumented fusion from L4 to pelvis which was managed successfully without revision or removal of implants. METHODS: We report a patient with high-grade spondylolisthesis who demonstrated loss of motor-evoked potentials after posterior spinal fusion and transfer to supine position. The patient's knees were flexed to 90° and signals were immediately restored. Systemic steroids were administered and circumferential fusion was delayed 21 days. Anterior-interbody cage was placed without complication. RESULTS: She was discharged on post-operative day 2. At 7 months, she is pain free and doing well with plans to return to gymnastics completely. CONCLUSIONS: Knee flexion can be instituted when encountering a neuromonitoring signal change following posterior spinal fusion for spondylolisthesis as a means to alleviate acute nerve stretch injury and may in some cases prevent the need to lessen the correction. LEVEL OF EVIDENCE: IV.
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