Intraoperative spinal cord monitoring during the surgical correction of scoliosis due to cerebral palsy and other neuromuscular disorders

Hammett, T.; Boreham, B.; Quraishi, Nasir A.; Mehdian, S. M. H.

doi:10.1007/s00586-012-2652-x

Cited by 40 publications

(23 citation statements)

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“…Those of us who do not use cord monitoring have the view that one is committed to decompressing the spinal cord and that spinal cord monitoring is not going to change the surgical objective. Those who use it, have a strategy in place should there be a deterioration in the neurophysiological function and this is not too dissimilar to worsening of neuromonitoring in scoliosis patients [41,42]. For example, stopping the procedure in cases of significant drops in intra-operative monitoring, performing a wake-up test or even abandoning the anterior approach and performing a staged posterior decompression to allow the spinal cord to 'float dorsally' are strategies that we have employed in the past.…”

Section: Discussionmentioning

confidence: 99%

Calcified giant thoracic disc herniations: considerations and treatment strategies

et al. 2014

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Introduction Giant herniated thoracic discs (GHTD) remain a surgical challenge. When combined with calcification, these discs require altered surgical strategies and have only been infrequently described. Our objective was to describe our surgical approaches in the management of calcified GHTD. Methods This was a retrospective cohort study of all patients with calcified GHTD operated between 2004 and 2012. Data were collected from review of patients' notes and radiographs and included basic demographic and radiological data, clinical presentation and outcome, operative procedure and complications. Results During the study period, there were 13 patients with calcified GHTD, including 6 males and 7 females (mean age 55 years, range 31-83 years). The average canal encroachment was 62 % (range 40-90 %); mean follow-up 37 months (12-98). All patients were treated with anterior thoracotomy, varying degrees of vertebral resection, removal of calcified disc and with or without reconstruction. The average time for surgery was 344 min (range 212-601 min) and estimated blood loss 1,230 ml (range 350-3,000 ml). Post-operatively, 8 patients improved by 1 Frankel grade (62 %), 2 improved by 2 grades (15 %) and 3 did not change their grade (23 %). The complication rate was 4/13 (31 %; 3 patients with durotomies (2 incidental, 1 intentional) and 1 with recurrence). Discussion Calcified GHTD remain a surgical challenge. Anterior decompression through a thoracotomy approach, and varying degrees of vertebral resection with or without reconstruction allowed us to safely remove the calcified fragment. All patients remained the same (23 %) or improved by at least 1 grade (77 %) neurologically, without radiographic failure at final follow-up.

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Section: Discussionmentioning

confidence: 99%

Calcified giant thoracic disc herniations: considerations and treatment strategies

et al. 2014

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“…Spinal cord monitoring in neuromuscular scoliosis is possible but potentially unreliable [22]. The inclusion of patients with neuromuscular scoliosis and patients with mild preoperative paralysis may have influenced our results.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of anesthetic fade in motor evoked potential monitoring in spinal deformity surgeries

et al. 2018

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BackgroundIntraoperative neuromonitoring using motor evoked potentials (MEP) satisfactorily detects motor tract integrity changes during spinal surgery. However, monitoring is affected by “anesthetic fade,” in which the stimulation threshold increases because the waveform amplitude decreases with the accumulation of propofol. Therefore, the purpose of this study was to clarify the effect of anesthetic fade on transcranial MEPs by investigating the time-dependent changes of amplitude during spinal deformity surgeries.MethodsWe retrospectively reviewed medical records of 142 spinal deformity patients (66 patients with idiopathic scoliosis, 28 with adult spinal deformities, 19 with neuromuscular scoliosis, 17 with syndromic scoliosis, and 12 with congenital scoliosis). The average age was 28 years (range, 5 to 81 years). MEPs were recorded bilaterally from the abductor digiti minimi (ADM) and abductor hallucis (AH) muscles during spinal deformity surgeries. The Wilcoxon signed-rank test was used to investigate the time-dependent changes of amplitude after propofol infusion to evaluate anesthetic fade effects.ResultsThe average time to baseline from initial propofol infusion was 113 min (range, 45 to 182 min). In the ADM, the amplitude was 52% at 1 h after initial propofol infusion, 102% at 2 h, 105% at 3 h, 101% at 4 h, 86% at 5 h, and 81% at 6 h. Compared to the 2-h time point, MEP decreased significantly by 16% at 5 h (P < 0.0005) and by 21% at 6 h (P < 0.05). In the AH, the amplitude was 49% at 1 h after initial infusion of propofol, 102% at 2 h, 102% at 3 h, 92% at 4 h, 71% at 5 h, and 63% at 6 h. Compared to the 2-h time point, MEP decreased significantly by 10% at 4 h (P < 0.005), by 31% at 5 h (P < 0.0000005), and by 39% at 6 h (P < 0.05).ConclusionsMEP amplitude significantly decreased in the upper limbs at 5 and 6 h and in the lower limbs at 4, 5, and 6 h after the initial infusion of propofol, respectively. The influence of anesthetic fade could influence false positive MEPs during long spinal surgeries.

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“…16,17 Several cases of false-negatives have been previously reported in patients with anterior tract deficits. 18,19 Studies suggest the increased metabolic rate of surviving motor neurons in polio may alter the susceptibility of motor neurons to anesthesia, 3,8,16 as described by Gyermek et al , 20 in which the recovery time and ED50 of several muscle relaxants (pancuronium, gallamine, tubocurarine) were compared between 30 pediatric patients with a history of polio infection and a 51-subject control group.…”

Section: Discussionmentioning

confidence: 99%

Complications and Outcomes of Complex Spine Reconstructions in Poliomyelitis-Associated Spinal Deformities

Godzik

Lenke²,

Holekamp³

et al. 2014

Spine

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Study Design Retrospective case-series Objective Share our institutional experience with spinal reconstruction for deformity correction in patients with a history of poliomyelitis. Background Data Polio and post-polio syndrome are not uncommonly related to a paralytic spinal deformity. Limited modern data exists regarding outcomes and complications following spinal reconstruction in this population. Methods A clinical database was reviewed for patients undergoing spinal reconstruction for polio-associated spinal deformity at our institution from 1985 to 2012. Relevant demographic, medical, surgical and postoperative information were collected from medical records and analyzed. Preoperative and last follow-up SRS-22 scores were recorded. Results A total of 22 patients with polio who underwent surgical deformity correction were identified. Mean age was 49 years (Range, 12–74), and 15 patients (68%) were female. Preoperative motor deficit was present in 14/22 (64%). All patients underwent instrumented spinal fusion (Mean 13 vertebral levels, Range, 3–18). Ten (10/22, 45%) patients developed major complications, and four patients (4/22, 18%) developed new postoperative neurological deficits. Neurological monitoring yielded a 13% false negative rate. At 2-year follow-up (20/22), patients maintained an average coronal correction of 25 degrees (33%, p = 0.001) and sagittal correction of 25 degrees (34%, p = 0.003). Minimum 2-year follow-up data were available for 11/22 (50%) of patients. At an average of 72 months of follow-up (Range, 28 – 134 months), the mean SRS22 pain subscore improved from a mean of 2.75 to 3.6 (p = 0.012); self-image from 2.8 to 3.7 (p = 0.041); function from 3.1 to 3.8 (p = 0.036); satisfaction from 2.1 to 3.9 (p = 0.08); mental health from 3.7 to 4.5 (p = 0.115). Conclusion Spine reconstruction for poliomyelitis-associated deformity was associated with high complication rates (54%) and sometimes unreliable neurologic monitoring data. Despite this, patients undergoing spine reconstructions had significantly improved outcomes scores. These data may help surgeons appropriately counsel this complicated patient population.

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Intraoperative spinal cord monitoring during the surgical correction of scoliosis due to cerebral palsy and other neuromuscular disorders

Cited by 40 publications

References 10 publications

Calcified giant thoracic disc herniations: considerations and treatment strategies

Calcified giant thoracic disc herniations: considerations and treatment strategies

An evaluation of anesthetic fade in motor evoked potential monitoring in spinal deformity surgeries

Complications and Outcomes of Complex Spine Reconstructions in Poliomyelitis-Associated Spinal Deformities

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