Intraoperative monitoring of somatosensory (SSEPs) and transcranial electric motor-evoked potentials (tce-MEPs) during surgical correction of neuromuscular scoliosis in patients with central or peripheral nervous system diseases

F. Pastorelli, M. Di Silvestre, F. Vommaro, E. Maredi, A. Morigi, M. R. Bacchin, S. Bonarelli, R. Plasmati, R. Michelucci, T. Greggi

Research output: Contribution to journalArticle

Abstract

Purpose: Combined intraoperative monitoring (IOM) of transcranial electric motor-evoked potentials (tce-MEPs) and somatosensory-evoked potentials (SSEPs) is safe and effective for spinal cord monitoring during scoliosis surgery. However, the literature data regarding the reliability of spinal cord monitoring in patients with neuromuscular scoliosis are conflicting and need to be confirmed. Methods: We reviewed IOM records of 40 consecutive patients with neuromuscular scoliosis related to central nervous system (CNS) (29 pts) or peripheral nervous system (PNS) (11 patients) diseases, who underwent posterior fusion with instrumentation surgery for spinal deformity. Multimodalitary IOM with SSEPs and tce-MEPs was performed. Results: Spinal cord monitoring using at least one modality was attempted in 38/40 (95 %) patients. No false-negative results were present in either group, but a relatively high incidence of false-positive cases (4/29, 13.8 %) was noted in the CNS group. Two patients in the CNS group and one patient in the PNS group presented transient postoperative motor deficits (true positive), related to surgical manoeuvres in two cases and to malposition in the other one. Conclusions: Multimodalitary IOM is safe and effective to detect impending spinal cord and peripheral nerves dysfunction in neuromuscular scoliosis surgery. However, the interpretation of neurophysiological data may be challenging in such patients, and the rate of false-positive results is high when pre-operatory motor deficits are severe.

Original languageEnglish
Pages (from-to)931-936
Number of pages6
JournalEuropean Spine Journal
Volume24
DOIs
Publication statusPublished - Nov 1 2015

Keywords

  • Intraoperative monitoring
  • Motor-evoked potentials
  • Neurologic deficit
  • Neuromuscular scoliosis
  • Spine surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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