అనస్థీషియా & క్లినికల్ రీసెర్చ్
అందరికి ప్రవేశం

నైరూప్య

Neural Complications of Surgical Treatment of Adolescent Idiopathic Scoliosis: a Single Center Experience

Filipa Pereira, Paula Sa, Daniel Soares, Luis Dias, Joana Gomes Dias, Antonio Oliveira and Humberto Machado

Objective: Adolescent idiopathic scoliosis surgery presents a challenge to anesthetist due to the extensive nature of the surgery and the constraints on anesthetic techniques of intraoperative neurophysiological monitoring of the spinal cord. Intraoperative neurophysiological monitoring combining both somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) have become a standard of care by preventing neurologic sequela and lesions of the spinal cord. The objective of this article was to assess the incidence of neural complications in surgical treatment of adolescent idiopathic scoliosis surgery in a single institution and investigate possible factors associated with it.

Methods: Medical records of 216 patients who underwent adolescent idiopathic scoliosis surgery with posterior spinal fusion were retrospectively reviewed from January 2009 to October 2013. Patients were monitored using electrophysiological methods including SSEPs and transcranial electric MEPs simultaneously.

Results: Neurophysiologic monitoring changes were seen in 5 patients (2.3%): 4 (75%) women and 1 (25%) men. Out of the 5 patients with significant signal alert, 3 patients presented changes in Tc-MEPs and 2 patients in Tc-MEPs and SSEPs. 3 patients presented intraoperative significant changes in neurophysiologic signals that improved following corrective actions by surgeons and correction of hemodynamic parameters by anesthesiologists with no postoperative neurologic deficits; 2 did not show any reversal of the signals after systemic intervention and developed postoperative neurologic deficits consisting of transient paraparesis (0.92%).

Conclusion: This study indicates that early detection of neurophysiological changes using a multimodal approach with SSEPs and Tc-MEPs affords the surgical team an opportunity to perform rapid intervention to prevent injury progression or the possibility to reverse impeding neurologic sequela.