Can Intraoperative Spinal Cord Monitoring Reliably Help Prevent Paraplegia During Posterior Vertebral Column Resection Surgery?

Cho, Samuel K.; Lenke, Lawrence G.; Bolon, Shelly M.; Pahys, Joshua M.; Cho, Woojin; Kang, Matthew M.; Zebala, Lukas P.; Koester, Linda A.

doi:10.1016/j.jspd.2014.06.013

Cited by 11 publications

(3 citation statements)

References 30 publications

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“…Injury to the spinal cord or the nerve roots is one of the most important complications of PVCR. (7,14). We have used neural intra-operative monitoring routinely and observed no exacerbation of the preoperatively existing neurologic status.…”

Section: █ Resultsmentioning

confidence: 99%

Improvement of life after pvcr in complete paraplegic patients with posttraumatic severe kyphosis

Karagüven

Benli²,

Acaroğlu³

et al. 2020

Turkish Neurosurgery

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AIM:To determine the effect of posterior vertebral column resection (PVCR) in patients with paraplegia by using the American Spinal Injury Association (ASIA) score and Scoliosis Research Society (SRS)-22 questionnaire. MATERIAL and METHODS:Twelve patients with posttraumatic paraplegia and severe angular kyphosis (>60⁰) had undergone PVCR between 6-24 months after the trauma for severe pain, persistent vertebral instability and difficulty in adherence to rehabilitation. ASIA scores and SRS-22 questionnaire results obtained in the preoperative and postoperative periods, and the last control were statistically compared to assess the presence of any change. RESULTS:The average age of twelve patients included in this study was 35.6 ± 10.2 (21-51) years. Female/male ratio was 2/10 (20.0%). The mean follow-up duration was 50.3 ± 17.6 (24-86) months. None of the patients had additional changes in neuromonitoring records during surgery. The mean preoperative kyphotic angle of the patients was 66.58° ± 7.1⁰ (60⁰-82⁰) which decreased to 7.0⁰ ± 5.4⁰ in the postoperative period (p<0.05). The mean ASIA score, which was 43.3 ± 5.1 preoperatively, increased to 44.4 ± 4.4 in the postoperative period. The SRS-22 score, which was 2.4 ± 0.3 in the preoperative period, increased to 4.2 ± 0.4 in the early postoperative period. This increase was found to be statistically significant (p<0.05). The SRS-22 score was 4.1 ± 0.4 at last follow-up and was not statistically different from the early postoperative value (p>0.05). CONCLUSION:In the light of these data, it can be stated that PVCR is a safe and reliable procedure in paraplegic patients with rigid posttraumatic kyphosis and increases patient satisfaction.

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Section: █ Resultsmentioning

confidence: 99%

Improvement of life after pvcr in complete paraplegic patients with posttraumatic severe kyphosis

Karagüven

Benli²,

Acaroğlu³

et al. 2020

Turkish Neurosurgery

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“…However, with various intraoperative responses including raising the MAP, removing any traction on the patient, or reversing previously applied correction maneuvers, all patients had return of data to acceptable limits without any major neurologic deficits sustained. 28 Jarvis et al demonstrates the effectiveness of MEP changes in guiding surgical intervention. The authors identified highrisk steps of the procedure and methods to successfully improve monitoring changes.…”

Section: Neurologic Complications In 3-column Osteotomiesmentioning

confidence: 99%

Section: Neurologic Complications In 3-column Osteotomiesmentioning

confidence: 99%

Neuromonitoring in Spinal Deformity Surgery: A Multimodality Approach

Laratta

Shillingford

et al. 2017

Global Spine Journal

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Study Design:Literature review.Objective:The aim of this study was to provide an overview of the available intraoperative monitoring techniques and the evidence around their efficacy in vertebral column resection.Methods:The history of neuromonitoring and evolution of the modalities are reviewed and discussed. The authors’ specific surgical techniques and preferred methods are outlined in detail. In addition, the authors’ experience and the literature regarding vertebral column resection and surgical mitigation of neurologic alarms are discussed at length.Results:Risk factors for signal changes have been identified, including preoperative neurologic deficit, severe kyphosis, increased curve magnitude, and significant cord shortening. Even though no evidence-based treatment algorithm exist for signal changes, strategies are discussed that can help prevent alarms and address them appropriately.Conclusion:Through implementation of multimodal intraoperative monitoring techniques, potential neurologic injuries are localized and managed in real time. Intraoperative monitoring is a valuable tool for improving the safety and outcome of spinal deformity surgery.

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