caa a22 4500 44583322X CHVBK 20180317145322.0 cr unu---uuuuu 170323e20110501xx s 000 0 eng 10.1007/s00586-011-1756-z doi (NATIONALLICENCE)springer-10.1007/s00586-011-1756-z The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring [Elektronische Daten] [F. Pastorelli, M. Di Silvestre, R. Plasmati, R. Michelucci, T. Greggi, A. Morigi, M. Bacchin, S. Bonarelli, A. Cioni, F. Vommaro, N. Fini, F. Lolli, P. Parisini] Iatrogenic spinal cord injury is the most feared complication of scoliosis surgery. The importance of combined somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) monitoring during spine surgery is well known. The current authors retrospectively evaluated the results of neurophysiological intraoperative monitoring (IOM) in a large population of patients who underwent surgical treatment for spinal deformity. Intraoperative monitoring of SEPs and transcranial electrical stimulation MEPs (TES-MEP) was performed in 172 successive patients who underwent surgical treatment of idiopathic (128 pts), congenital (15 pts) or syndromic (29 pts) scoliosis. The first 106 patients (Group 1) underwent only SEP monitoring, while the other 66 patients (Group 2) underwent combined SEP and TES-MEP monitoring, when the technique was introduced in the current authors' institution. Halogenate anaesthesia (Sevoflurane, MAC 0.6-1.2) was performed in Group 1 cases, total intravenous anaesthesia (Propofol infusion, 6-10mg/kg/h) in Group 2 patients. A neurophysiological "alert” was defined as a reduction in amplitude (unilateral or bilateral) of at least 50% for SEPs and of 65% for TES-MEPs compared with baseline. In Group 1, two patients (1.9%) developed postoperative neurologic deficits following surgical correction of spinal deformity, consisting of permanent paraparesis in one case and transient paraparesis secondary to spinal cord ischaemia in the other. Twelve patients presented intraoperative significant changes of neurophysiological parameters that improved following corrective actions by surgeons and anaesthesiologists, and did not show any postoperative neurologic deficits. In ten cases the alert was apparently unrelated to surgical manoeuvres or to pharmacological interventions and no postoperative neurologic deficits were noted. Considering the patients of Group 2, two patients (3.0%) presented transient postoperative neurologic deficits preceded by significant intraoperative changes in SEPs and TES-MEPs. In five cases a transient reduction in the amplitudes of SEPs (1 patient) and/or TES-MEPs (5 patients) was recorded intraoperatively with no postoperative neurologic deficits. In conclusion, in the current series of 172 patients the overall prevalence of postoperative neurologic deficit was 2.3% (4 patients). When combined SEP and TES-MEP monitoring was performed, the sensitivity and specificity of IOM for sensory-motor impairment was 100 and 98%, respectively. Combined SEP and TES-MEP monitoring must be regarded as the neurophysiological standard for intraoperative detection of emerging spinal cord injury during corrective spinal deformity surgery. Early detection affords the surgical team an opportunity to perform rapid intervention to prevent injury progression or possibly to reverse impending neurologic sequelae. Springer-Verlag, 2011 Neurophysiological intraoperative monitoring nationallicence Somatosensory evoked potentials nationallicence Motor evoked potentials nationallicence Scoliosis nationallicence Postoperative complications nationallicence Pastorelli F. Servizio di Neurofisiopatologia, Istituti Ortopedici Rizzoli, Bologna, Italy aut Di Silvestre M. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut Plasmati R. Servizio di Neurofisiopatologia, Istituti Ortopedici Rizzoli, Bologna, Italy aut Michelucci R. UOC Neurologia, Ospedale Bellaria, Via Altura 3, 40139, Bologna, Italy aut Greggi T. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut Morigi A. Servizio di Anestesia e Rianimazione, Istituti Ortopedici Rizzoli, Bologna, Italy aut Bacchin M. Servizio di Anestesia e Rianimazione, Istituti Ortopedici Rizzoli, Bologna, Italy aut Bonarelli S. Servizio di Anestesia e Rianimazione, Istituti Ortopedici Rizzoli, Bologna, Italy aut Cioni A. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut Vommaro F. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut Fini N. UOC Neurologia, Ospedale Bellaria, Via Altura 3, 40139, Bologna, Italy aut Lolli F. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut Parisini P. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut European Spine Journal Springer-Verlag 20(2011-05-01), 105-114 0940-6719 20<105 2011 20 586 https://doi.org/10.1007/s00586-011-1756-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-011-1756-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Pastorelli F. Servizio di Neurofisiopatologia, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Di Silvestre M. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Plasmati R. Servizio di Neurofisiopatologia, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Michelucci R. UOC Neurologia, Ospedale Bellaria, Via Altura 3, 40139, Bologna, Italy aut NATIONALLICENCE 700 1- Greggi T. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Morigi A. Servizio di Anestesia e Rianimazione, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Bacchin M. Servizio di Anestesia e Rianimazione, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Bonarelli S. Servizio di Anestesia e Rianimazione, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Cioni A. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Vommaro F. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Fini N. UOC Neurologia, Ospedale Bellaria, Via Altura 3, 40139, Bologna, Italy aut NATIONALLICENCE 700 1- Lolli F. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 700 1- Parisini P. Chirurgia delle Deformità del Rachide, Istituti Ortopedici Rizzoli, Bologna, Italy aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20(2011-05-01), 105-114 0940-6719 20<105 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer