title: Pedicle screw position changing policy for nerve injury problems during screw insertion on thoracolumbar compression fractures.
abstract: BACKGROUND
  Intraoperative neurophysiologic monitoring (IONM) had important role related to the complications in spinal surgery. Somatosensory Evoked Potential (SSEP), Transcranial electric Muscle Evoked Potentials (tceMEPs), and free run EMG are parameters used to asses functional integrity of the nervous system during surgical procedures. Once warning signal was recognized, surgeon have to make a precise decision to overcome that problem.
  
  
  METHODS
  We present a 47-year old male with back pain due to compression fracture of thoracic vertebra T12 and lumbar vertebrae L1. While stabilizing through the posterior approach on the T11 and 12 as well as L2 and L3, the SSEP monitor showed 50% reduction in the waveform as the pedicle screw was inserted at the left side of T12. The instrumentation was changed into vertebra thoracal T10, T11, and vertebrae lumbar L2, L3. The SSEP normalized and post operatively pain decreased. After surgery there was no neurological deficit.
  
  
  CONCLUSIONS
  Acute trauma as a result of spine instrumentation may provoke significant edema, with mass effect causing neurophysiological dysfunction. Administration of intravenous steroid would do at this stage, followed by constant infusion for following 24-48h, may help ameliorating the mass effect and improving the neurologic outcome. Alternatively, immediate pedicle screw changing policy showed absolute recovery of nerve injury.
  
  
  CONCLUSIONS
  Insertion of pedicle screw in spinal surgery has a risk of complication that could be treated by pedicle screw changing policy.
authors.affiliation: Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10320, Indonesia. Electronic address: rahyussalim71@ui.ac.id.
authors.forename: Ahmad Jabir
authors.initials: AJ
authors.lastname: Rahyussalim
authors.affiliation: Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10320, Indonesia.
authors.forename: Ifran
authors.initials: I
authors.lastname: Saleh
authors.affiliation: Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10320, Indonesia.
authors.forename: M Fajrin
authors.initials: MF
authors.lastname: Armin
authors.affiliation: Stem Cell and Tissue Engineering Cluster, MERC Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10320, Indonesia.
authors.forename: Tri
authors.initials: T
authors.lastname: Kurniawati
authors.affiliation: Neurophysiology Division of Neurology Departement, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10320, Indonesia.
authors.forename: Ahmad Yanuar
authors.initials: AY
authors.lastname: Safri
keywords: Intra operative monitoring; Nerve injury; Pedicle screw placement; SSEP