Multimodality Intraoperative Neuromonitoring in Severe Thoracic Deformity Posterior Vertebral Column Resection Correction

Huang, Zifang; Chen, Liuyun; Yang, Jing; Deng, Yong; Sui, Wenyuan; Yang, Junlin

doi:10.1016/j.wneu.2019.03.140

Cited by 22 publications

(24 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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“…Furthermore, the multimodality evoked potential (MEP/SEP/DNEP) monitoring method provides real-time neurological evaluation of spinal cord function and allow more aggressive surgical correction than could been undertaken previously [ 32 ]. According to our previous study, the SEP+MEP+DNEP model can effectively reduce neurological complication rates in surgery to correct spinal deformities [ 17 ]. However, this model is not extensively applied in clinical practice compared with the SEP+MEP model, which is due to its relatively complex manipulation and relatively high aseptic requirements.…”

Section: Discussionmentioning

confidence: 99%

“…However, during surgery to correct severe scoliosis, osteotomy causes massive blood loss, which easily injures the spinal cord blood supply, leading to so-called iatrogenic spinal cord ischemic injury during osteotomy [ 15 , 16 ]. Our previous work showed that osteotomy gap closure and osteotomy have been recognized as 2 surgical stages that have the greatest neurological risks in vertebral column resection surgeries [ 17 ]. The required monitoring mode should also be adapted to the surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of Surgical Correction for Spinal Deformity with and without Osteotomy to Compare Outcome Using Intraoperative Neurophysiological Monitoring with Evoked Potentials

et al. 2020

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Background This study aimed to evaluate the effects of different combined evoked potentials monitoring modes for non-osteotomy and osteotomy surgery of spinal deformity, and to select individualized modes for various surgeries. Material/Methods We retrospectively reviewed a total of 188 consecutive cases undergoing spinal deformity correction. All patients were classified into 2 cohorts: non-osteotomy (Group A) and osteotomy (Group B). According to intraoperative evoked potential monitoring mode, Group A was divided into 2 sub-groups: A1 [spinal somatosensory evoked potential (SSEP)/motor evoked potential (MEP), n=67)] and A2 [SSEP/MEP/descending neurogenic evoked potential (DNEP), n=52]. Group B was classified as B1 (SSEP/MEP, n=27) and B2 (SSEP/MEP/DNEP, n=42). The demographics, surgical parameters, and evoked potential events of different combined monitoring modes were analyzed within each group. Results The baselines of SSEP/MEP/DNEP in all cases were elicited successfully. Three cases with evoked potential (EP) events (2 with MEP changes and 1 with SSEP/MEP change) were noted in Group A1 and 1 with SSEP change in Group A2, with no neurological complications. Thirteen cases in Group B1 were positive for MEP intraoperatively, including 16 EP events (13 with MEP change and 3 with both SSEP+MEP changes), with no neural complications. In Group B2, 15 cases had 21 EP events, including 12 with MEP change and 2 with SSEP+MEP changes, with no complications. Postoperative neurological complications were observed in 5 of the 7 cases with SS4EP/DNEP changes. Conclusions Intraoperative simultaneous SSEP/MEP can effectively reflect neurological function in non-osteotomy spinal surgery patients. Simultaneous SSEP/MEP/DNEP can effectively avoid the unnecessary interference by false-positive results of MEP during osteotomy.

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“…Posterior vertebral column resection (PVCR) has become a useful technique for treatment of severe and rigid spinal deformity; meanwhile it is one of biggest spinal surgeries and at higher risk of excessive blood loss and neurological deficits [1][2][3][4]. When surgeons were performing an osteotomy at the thoracic region, the nerve root of the corresponding section was often sacrificed.…”

Section: Introductionmentioning

confidence: 99%

A rare intraoperative spinal cord injury caused by thoracic 8 nerve root interruption during posterior vertebral column resection surgery for severe congenital kyphoscoliosis: a case report

Wang¹,

Ren²,

Yang³

et al. 2020

BMC Neurol

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Background: To our knowledge, the exposed nerve roots in thoracic spine are usually sacrificed to facilitate osteotomy during posterior vertebral column resection (PVCR) for severe spinal deformity. Currently we report a case with severe spine deformity in which intraoperative neurological monitoring (IOM) loss after interrupting T8 nerve root finally led to spinal cord injury during PVCR surgery. Case presentation: The patient was a 14-year-old female with severe congenital kyphoscoliosis (CKS) without preoperative neurologic deficits. The IOM events (MEP loss and SSEP latency prolong) were showed when T8 nerve root at concave side was interrupted. And then we reduce the scope of osteotomy to control bleeding, raised blood pressure (MAP, 65-80) to increase blood supply for spinal cord, placed the bilateral rod to stabilized the spinal cord, used the methylprednisolone, explored the presence or absence of spinal cord compression, and prepared to change the surgical plan from PVCR to PSO. After that the IOM signals partial recovered from the lowest point. Postoperatively the patients showed transient motor function deficits of left lower limbs weak without somatosensory deficits, and come back to preoperative status 6 months later. Conclusions: Interrupting the thoracic spine nerve root is danger to trigger the spinal cord injury during PVCR procedure of severe CKS. That probably because the increasing tension of contralateral anterior horn area of spinal cord via the nerve root pulling.

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Multimodality Intraoperative Neuromonitoring in Severe Thoracic Deformity Posterior Vertebral Column Resection Correction

Cited by 22 publications

References 30 publications

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

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

A Retrospective Study of Surgical Correction for Spinal Deformity with and without Osteotomy to Compare Outcome Using Intraoperative Neurophysiological Monitoring with Evoked Potentials

A rare intraoperative spinal cord injury caused by thoracic 8 nerve root interruption during posterior vertebral column resection surgery for severe congenital kyphoscoliosis: a case report

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