INTRAOPERATIVE NEUROMONITORING DURING SURGICAL CORRECTION OF SPRENGEL’S DEFORMITY

Abstract

Introduction Neuromonitoring (IOM) is a procedure for verification of the nerve impulse transmission along structures of central and peripheral nervous system during surgical procedures. Motor evoked potentials (MEPs) recordings from muscles induced with electrical pulses transcranially to motor cortex centers are especially useful during the surgery with an increased risk of iatrogenic damage to efferent nerve structures. Aim of the study The aim of this report is to present the scenario of the reversible inhibition in pathways transmitting nerve impulses during surgical correction of Sprengel’s deformity with the assessment of IOM. Material and methods Nine-year old girl was admitted to the hospital due to congenital high scapula. Corrective surgery was performed using the Woodward technique with an assessment of IOM. Results The amplitudes and latencies of the MEPs from muscles of upper right extremity were recorded as decreased and increased, respectively at about 20% during the final fixation of scapula. Thanks to these recordings surgeons could prevent the permanent damage of the brachial plexus fibers, by partial releasing of applied sutures. After surgery and subsequent rehabilitation the patient returned to the normal activity in right upper extremity. Association of electromyography and MEPs results helped with ordering and controlling the course of treatment. Conclusions The benefit of IOM relay on the safety of orthopedic surgery and decreasing the number of iatrogenic perioperative complications. This diagnostic procedure is also a strong point for argumentation in hospital administration during negotiations with lawyer representing the patient when iatrogenic complication appear.