Feng Lei,Zhang Xuejun,Qi Xinyu,et al.Application of intraoperative neurophysilogical monitoring during hemivertebra resection for congenital scoliosis in children[J].Journal of Clinical Pediatric Surgery,,17():673-676.
Application of intraoperative neurophysilogical monitoring during hemivertebra resection for congenital scoliosis in children
- Keywords:
- Congenital scoliosis; Hemivertebra resection; IONM; Somatosensory evoked potential; Motor evoked potential
- Document code:
- A
- Abstract:
- Objectives To analyze the necessity of intraoperative neurophysiological monitoring during congenital scoliosis who were treated with posterior hemivertebra resection. Methods A prospective database was reviewed, evaluated the results of neurophysiological intraoperative monitoring (IONM) in a large population of patients who underwent posterior hemivertebra resection for congenital scoliosis. Intraoperative monitoring of SEPs and transcranial electrical stimulation MEP was performed in 134 successive patients (63 males and 71 females). Acceptable baseline responses were obtained before screw insertion. Anesthetic,intraoperative body temperature, blood pressure were examined in patients with and without waveform deterioration. A neurophysiological alert was defined as a reduction in amplitude (unilateral or bilateral) of at least 50% or latent period extending by 10% for SEP and of 70% for MEP compared with baseline. Results All of the patients had the baseline of SEP，97.8%(3 failed) of the patients had the baseline of MEP .Sixteen patients (12%) exhibited an intraoperative waveform change of SEP, they were recorded intraoperatively with no postoperative neurologic deficits. Five patients (3.7%) exhibited an intraoperative waveform change,and these occurred after screw fixation(0.7%), during rotation maneuver after hemivertebra resection (2.9%), and after intervertebral compression (7%). Most waveform changes recovered after decreased correction or rest. No patient had a motor deficit postoperatively. Conclusions Spinal cord injury often occurred during screw insertion , hemivertebra resection ,and after intervertebral compression. Combined SEP and MEP monitoring could afford the surgical team an opportunity to perform rapid intervention to prevent injury progression or possibly to reverse impending neurologic sequelnce.
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