Scoliosis Corrective Surgery With Continuous Intraoperative Neurophysiological Monitoring (IONM)

Scoliosis is a spine deformity that presents as Cobb’s angle greater than 10 degrees. Pedicle screw placement can be employed in scoliosis corrective procedures but poses a danger of disrupting the motor and sensory pathways by injuries to the nerves, spinal cord, and vasculature. Occasionally traction weight is applied before the instrumentation for correction. This correction weight may cause spinal cord functional compromise and may result in postoperative paresis or paralysis. A 10-year-old female patient with Cobb's angle of 120 degrees was scheduled for scoliosis correction surgery. A multimodality intraoperative neurophysiological monitoring (IONM) approach was designed with somatosensory evoked potentials (SSEPs), transcranial electrical motor evoked potentials (TCeMEPs), spontaneous electromyography (s-EMG), triggered electromyography (t-EMG) and train of four (TOF). In this patient, after placing the pedicle screw, TCeMEP changes were immediately identified and reported to the surgeon in the left lower extremity followed by both lower extremities. The surgeon immediately asked the anesthesiologist to remove 25 pounds of traction weight from the head and increase the mean arterial pressure. TCeMEP responses returned to the baselines immediately. Later during the surgery, left arm SSEP changes were also identified, which returned to normal on the repositioning of the arm. Multimodal IONM has the benefit of monitoring the sensory and motor functions of the spinal cord and nerve function at risk of damage during the procedure. The utilization of IONM in this spinal cord correction surgery helped to detect and timely reverse nerve injuries. We strongly recommend utilizing multimodality IONM during scoliosis correction procedures as a standard of care to minimize postoperative neurological deficits.