A multimodal approach to intraoperative neuromonitoring of the spinal cord during spinal deformity correction

Abstract

Objective. To analyze the results of a multimodal approach in intraoperative neurophysiological monitoring during surgical correction of spinal deformities.Material and Methods. The paper describes a variant of intraoperative neurophysiological monitoring of the spinal cord and nerve root functions which was used in the correction of scoliotic deformity of the spine in 138 patients. Surgery was performed in 83 patients aged 10 to 17 years and in 55 patients older than 17 years. The average age of patients was 20.23 ± 8.3 years. There were 41 male and 97 female patients. The primary scoliotic curve was localized in the thoracic spine in 90 cases, in the thoracolumbar spine in 27 cases, and in the lumbar spine in 21 cases.Results. In the early postoperative period, two patients developed neurological deficit, the electrophysiological predictors of which were recorded during intraoperative neurophysiological monitoring. In one case, the deficit gradually regressed completely due to the measures taken by the operating team during surgery; in the second case, a persistent neurological deficit in the form of lower paraplegia persisted, despite the measures taken during the surgical treatment. In other cases, intraoperative neurophysiological monitoring did not reveal any changes in the spinal cord and nerve roots, which in the early postoperative period would lead to the appearance or aggravation of motor deficit.Conclusion. A multimodal approach to intraoperative neurophysiological monitoring provides an operating surgeon with an objective assessment of the state of the spinal cord and nerve roots at any stage of surgery, which allows timely identification and elimination of the causes of their damage, thereby reducing the likelihood of neurological deficit development or aggravation in the postoperative period.