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.
OBJECTIVE
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.
Neurophysiology Serv., Rizzoli Orthopedic Institute, Bologna, Italy. francesca182@gmail.com.|Department Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche, Via Altura 3, 40139, Bologna, Italy. francesca182@gmail.com.
F
http://orcid.org/0000-0002-3878-4512
F
Pastorelli
Spinal Deformity Surgery Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
M
M
Di Silvestre
Spinal Deformity Surgery Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
F
F
Vommaro
Spinal Deformity Surgery Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
E
E
Maredi
Anesthesiology Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
A
A
Morigi
Anesthesiology Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
M R
MR
Bacchin
Anesthesiology Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
S
S
Bonarelli
Department Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche, Via Altura 3, 40139, Bologna, Italy.
R
R
Plasmati
Department Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche, Via Altura 3, 40139, Bologna, Italy.
R
R
Michelucci
Spinal Deformity Surgery Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
T
T
Greggi
D000293:Adolescent; D000328:Adult; D002493:Central Nervous System Diseases / Q000150:complications*; D002648:Child; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D010523:Peripheral Nervous System Diseases / Q000150:complications*; D015203:Reproducibility of Results; D012600:Scoliosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
Intraoperative monitoring; Motor-evoked potentials; Neurologic deficit; Neuromuscular scoliosis; Spine surgery