title: Bilateral femoral artery ischemia detected by multimodality neuromonitoring during posterior scoliosis surgery: a case report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report a case of a bilateral femoral artery ischemia detected by neuromonitoring during posterior scoliosis surgery and to review relevant literature regarding this rare complication.
  
  
  BACKGROUND
  Lower extremity ischemia is a potentially devastating risk of posterior spinal surgery. Ischemia can be a result of thrombotic occlusion or vascular compression during patient positioning. Multimodality neuromonitoring, increasingly used to prevent neurologic injury, can also detect hypoperfusion to the extremities. To date, there have been no reports of bilateral lower extremity ischemia detected by multimodality neuromonitoring during posterior spine surgery.
  
  
  METHODS
  A 15-year-old boy with adolescent idiopathic scoliosis underwent posterior spinal fusion with instrumentation. Intraoperative changes in somatosensory-evoked potentials and motor-evoked potentials were noted 1 hour into the case, before instrumentation or the reduction maneuver. After trouble shooting methods did not localize a technical cause for the changes, the patient's lower extremities were noted to be hypoperfused and pulseless.
  
  
  RESULTS
  The patients was repositioned and lower extremity perfused improved. Palpable distal pulses were detected. Neuromonitoring signals returned to baseline and the surgery completed. The patient had no postoperative neurologic or vascular deficits.
  
  
  CONCLUSIONS
  Lower extremity ischemia secondary to prone positioning is a rare risk of posterior spinal surgery. This is the first case report of this potentially devastating, but preventable complication detected by multimodality neuromonitoring.
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI 48073, USA. mdtseng@hotmail.com
authors.forename: Michael D
authors.initials: MD
authors.lastname: Tseng
authors.forename: Lawrence
authors.initials: L
authors.lastname: Cappetto
authors.forename: Kamran
authors.initials: K
authors.lastname: Majid
authors.forename: Douglas
authors.initials: D
authors.lastname: Sternberg
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Settecerri
mesh_terms: D000293:Adolescent; D000075202:Contraindications; D005263:Femoral Artery / Q000503:physiopathology*; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D056888:Patient Positioning / Q000009:adverse effects* / Q000592:standards; D012600:Scoliosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods