Spinal Cord Monitoring Research Articles

An evaluation of multimodal spinal cord monitoring in scoliosis surgery: a single centre experience of 354 operations.

To evaluate the effectiveness of multimodal intraoperative neuromonitoring in the early detection of impending spinal cord injury during surgery for spinal deformity. A retrospective review of prospectively collected data in 354 consecutive spinal deformity operations from June 2003 to October 2013. Patients were sub-grouped according to demographics, diagnosis and operative features. Post-operative neurological deficit was defined as either spinal cord, nerve root or transient deficit. Combined monitoring with SSEPs and MEPs was possible in 315 cases. The overall incidence of significant alerts was 7.1% and overall permanent neurological deficit was 1.6%. When results were collated, the overall combined sensitivity of multimodal monitoring was 100% with a specificity of 99.3%. Multimodal monitoring allows early detection of impending neurological deficit that is superior to a single monitoring modality. To achieve optimal use of monitoring, continuous communication between surgical, anaesthetic and neurophysiology teams are required. As a result of our experience we have incorporated in our consent procedure the discussion of monitoring and the possibility of needing to abandon the procedure, and completing in a staged fashion at a later date. We believe multimodal monitoring is the current gold standard for complex spinal deformity surgery.

Lumbar nerve root mapping by the spinal cord monitoring in adult spinal deformity surgery

Objective When we perform surgical correction for spinal deformity with degenerative changes, nerve root impingement, traction, or nerve root injury could be occurred. Electromyographic (EMG) monitoring provides a real-time measure of impending spinal nerve root injury during instrumented posterior lumbar fusion. However, the utility of intraoperative EMG monitoring is still questionable because of large variance in muscle domination, morphological abnormality and the abnormal EMG signal from a nearby muscle. The aim of this study was identified clinical mapping of lumbar nerve root motor domination under EMG monitoring in the patients who had normal root morphology.

Can Intraoperative Spinal Cord Monitoring Reliably Help Prevent Paraplegia During Posterior Vertebral Column Resection Surgery?

Study DesignRetrospective case series. ObjectiveAnalyze patients who underwent posterior vertebral column resection (PVCR) above the conus medullaris with intraoperative spinal cord monitoring (SCM) data loss. Summary of Background DataPVCR is a powerful technique for treating severe spinal deformity but carries a high risk for major spinal cord deficits. MethodsWe assessed clinical, radiographic, and electrophysiologic monitoring and operative records of 90 consecutive adult and pediatric patients (mean age, 24.8 years; range, 7.5–76.8) who underwent PVCR above the conus medullaris for severe spinal deformity performed from 2002 to 2010 by one surgeon at one institution. ResultsFifteen of 90 patients (16.7%) (10 male/5 female; mean age, 15 years) lost SCM (n = 13) or had data degradation meeting warning criteria (n = 2). Diagnoses were kyphoscoliosis (n = 8), angular kyphosis (n = 3), global kyphosis (n = 2), and severe scoliosis (n = 2). Seven were revisions. The average pre-/postoperative scolioses were 99° (range, 32°–152°) and 43° (range, 6°–76°), respectively. The average pre-/postoperative kyphoses were +100° (range, 60°–170°) and +54° (range, 28°–100°), respectively. SCM fluctuated during osteotomy on nine occasions, stabilizing with elevation of blood pressure in addition to anterior spinal cord decompression in four, correction of subluxation in one, and traction reduction in one. Seven patients had SCM changes during rod compression. Three required partial release of correction, two larger cage insertion, one subluxation correction, and one pedicle screw removal. One experienced changes during rod placement/removal, and another, as a result of hypothermia. Data returned in all after prompt intervention (mean, 10.1 minutes; range, 1–60) and all awoke with intact lower extremity function. ConclusionThe prevalence of SCM changes during PVCR above the conus medullaris was 16.7%, mostly during osteotomy and rod/screw compression. Data returned with prompt intervention and all had intact lower extremity motor function postoperatively. These SCM “saves” strongly emphasize the importance of multimodality neurophysiologic monitoring during high-risk cases, minimizing postoperative complications.

Spinal Cord Monitoring Data in Pediatric Spinal Deformity Patients With Spinal Cord Pathology

Study DesignRetrospective. ObjectivesThe purpose of this study is to review the efficacy of monitoring data and outcomes in pediatric patients with spinal cord pathology. Summary of Background DataThe incidence of spinal cord pathology in pediatric patients with scoliosis has been reported between 3% and 20%. Previous studies demonstrated that intraoperative spinal cord monitoring (IOM) during scoliosis surgery can be reliable despite underlying pathology. MethodsA single-center retrospective review of 119 spinal surgery procedures in 82 patients with spinal cord pathology was performed. Diagnoses included Arnold-Chiari malformation, syringomyelia, myelomeningocele, spinal cord tumor, tethered cord, and diastematomyelia. Baseline neurologic function and history of prior neurosurgical intervention were identified. Outcome measures included ability to obtain reliable monitoring data during surgery and presence of postoperative neurologic deficits. Results were compared for 82 patients with adolescent idiopathic scoliosis (AIS). ResultsUsable IOM data were obtained in 82% of cases (97/119). Twenty-two cases (18%) had no lower extremity data. Patients with Arnold-Chiari malformation or syringomyelia pathologies, in isolation or together, had a significantly higher rate of reliable data compared to other pathologies (p < .0001). Among study group cases with usable data, there were 1 false negative (1%) and 4 true positive (4%) outcomes. There were no permanent neurologic deficits. The spinal cord pathology group demonstrated 80% sensitivity and 92% specificity. ConclusionsSpinal cord monitoring is a valuable tool in pediatric patients with spinal cord pathology undergoing spinal deformity surgeries. When obtained, data allow to detect changes in spinal cord function. Patients with a diagnosis of Arnold-Chiari or syringomyelia have monitoring data similar to those patients with AIS. Patients with other spinal cord pathologies have less reliable data, and surgeons should have a lower threshold for performing wake-up tests to assess spinal cord function intraoperatively.

Intraoperative Spinal Cord and Nerve Root Monitoring: A Pilot Survey

Intraoperative Spinal Cord and Nerve Root Monitoring: A Pilot Survey

P07.02 * THE ROLE OF INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING IN SURGERY OF INTRADURAL EXTRAMEDULLARY SPINAL CORD TUMORS

INTRODUCTION: Surgery of intradural extramedullary spinal cord tumors (IESCT) carries the risk of new neurological deficits in the post-operative period. Intraoperative neurophysiological monitoring (IONM) represents the most effective technique able to improve clinical and functional outcomes, which are obtained through identification and real-time intraoperative monitoring of spinal cord, giving informations about neurological conduction of both, spinal cord long pathways and cauda equina radices. The most widely used and reliable techniques are somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs) and D-wave registration. Although in the literature there are recent evidences of the IONM usefulness, there are not uniform opinions about the different techniques employed, and, their use in IESCT. In the present study we describe the results in our 2-year experience at the Neurosurgery of the University of Messina Hospital. MATERIALS AND METHODS: Our protocol includes evaluation of SEPs from posterior tibial nerve stimulation, MEPs obtained with elevate voltage electrical transcranial stimulation (through multiple myomeric registration of motor evoked responses from inferior limbs), D-Wave registration (through epi- and intradural registration after single pulse electrical transcranial stimulation) in spinal tumor surgery. RESULTS: We did not recorded any intraoperative complication by the use of our IONM protocol. In all patients IONM was useful for correct neurological and functional identification of spinal cord. We observed an optimal correlation between neurological examination on admission and responses from IONM of inferior limbs SEPs and MEPs. In fifty percent of patients, the D-wave registration was the most useful intraoperative tool, due to the lack of motor and somatosensory evoked responses. We matched all pre and post-operative neurological and neurophysiological data, along with tumors' features (localization, dimensions and histology) in order to quantify the impact of IONM on outcome. In our series, none of the patients presented with neurological worsening in the post-operative period. Conversely, surgical treatment of IESCT lead to a significant improvement of neurological status of our patients. CONCLUSIONS: Our preliminary data, although based on a limited series of patients evaluated at a single institution, confirm the role of IONM as an essential tool in operative work-up of all spine surgeries, including IESCT, to achieve an optimal post-operative functional outcome. This study gives further evidences about relevance, impact and usefulness of IONM in IESCT surgery.

Revision Versus Primary Patients Undergoing Vertebral Column Resection for Severe Spinal Deformities

Study DesignRetrospective comparative study. ObjectivesTo compare correction rates and complications of revision versus primary patients undergoing vertebral column resection (VCR). Summary of Background DataAlthough an all-posterior VCR has obviated the need for a circumferential approach, it is technically demanding, especially in a revision setting. MethodsBetween 2002 and 2009, 55 revision patients underwent a posterior-only VCR. Diagnoses included severe scoliosis (n = 3), kyphoscoliosis (KS) (n = 29), global kyphosis (GK) (n = 13), and angular kyphosis (AK) (n = 10). Radiographic findings and complications were compared with 38 primary patients who underwent a VCR during the same period. All patients had a minimum 2-year follow-up (range, 2–6 years). ResultsThe mean number of VCR levels were 1.6 in revision versus 1.2 in primary cases (p = .005). In the severe scoliosis and KS groups, major coronal curve correction was 48% in revision versus 63% in primary cases (p = .001). In the KS, GK, and AK groups, the major sagittal curve correction was 52% in revision versus 57% in primary cases (p = .27). Preoperative (p = .015) and postoperative (p = .002) sagittal imbalance was significantly greater in the revision group. There were no spinal cord–related complications, but 7 revision (13%) and 3 primary (8%) patients temporarily lost neuromonitoring data or failed wakeup tests; however, none had a permanent neurological deficit. Six revision patients (11%) required further revision surgery due to implant failure (3), progressive sagittal or coronal imbalance (2), and delayed deep wound infection (1) versus only 1 primary patient (3%) due to increased coronal imbalance. Preoperative and postoperative Scoliosis Research Society scores were not significantly different between groups. ConclusionsVertebral column resections in revision patients may be more technically demanding than in primary patients but can be performed safely in conjunction with intraoperative spinal cord monitoring. Revision and primary patients undergoing a VCR showed improved clinical outcomes.

Effects of different etomidate doses on intraoperative somatosensory-evoked potential monitoring.

Somatosensory-evoked potentials (SSEPs) are widely used for intraoperative spinal cord monitoring. Although many general anesthetics inhibit SSEPs, etomidate has been reported to boost SSEPs. This clinical study aimed to test whether etomidate doses less than 0.3mg/kg amplify SSEP monitoring. Patients were divided into four groups: A, B, C, and D. Etomidate doses of 0.1, 0.2, and 0.3mg/kg were infused into patients in groups A, B, and C, respectively, after baseline SSEPs were obtained. Group D patients were infused with saline. In the subsequent 15min, the amplitudes and latencies of SSEPs were recorded and compared. Etomidate exhibited amplification effects on SSEPs, and this effect increased with dose escalation. The amplitude changes in groups A, B, and C were significantly different (P=0.002, P=0.000, and P=0.000, respectively) from that of group D. The amplitude change was largest in group C and significantly greater than those in groups A and B (P=0.006, P=0.000). Latency was not significantly affected (P<0.05) by etomidate. Small doses of etomidate that were less than 0.3mg/kg had dose-related amplification effects on SSEP monitoring.

Wake-up test in total hip arthroplasty with high-riding developmental dysplasia.

Total hip arthroplasty (THA) for patients with Crowe type IV developmental dysplasia of the hip is technically challenging. This group of patients has a higher incidence of nerve injury during THA. Although neurophysiologic intraoperative monitoring has been developed to provide nerve monitoring, it is not always available. The wake-up test has been used for intraoperative spinal cord monitoring during major spinal surgery, but no study has reported the use of the wake-up test for neurologic monitoring during THA in patients with severe developmental dysplasia of the hip. The authors retrospectively reviewed 22 THA procedures in 20 patients with Crowe type IV developmental dysplasia of the hip who underwent the wakeup test during THA. In the current study, 1 patient could not dorsiflex her foot during the wake-up test. Therefore, the authors immediately reduced the length of limb lengthening by 1 cm. Postoperative drop foot and numbness occurred but resolved completely 2 months later. None of the patients who showed no deficits in motion of the feet during the intraoperative wake-up test had signs of postoperative nerve injury. In the current study, there was no false-positive or false-negative finding. The authors concluded that the wake-up test, which is simple, safe, and reliable, is a useful technique and a possible alternative to neurophysiologic intraoperative monitoring in checking nerve function during THA in patients with severe developmental dysplasia of the hip.

Radiographical and Clinical Outcomes of Posterior Column Osteotomies in Spinal Deformity Correction

Prospectively enrolled, retrospectively analyzed case series. To evaluate a large series of pediatric patients/patients with adult spinal deformity undergoing surgery with posterior column osteotomies (PCOs). Osteotomies of the posterior column (Smith-Petersen or Ponté) are used to reduce kyphosis, increase lordosis, or increase spinal flexibility. However, little focused evidence exists regarding the efficacy and safety of this technique. A total of 128 consecutive patients underwent posterior spinal fusion with PCOs with minimum 2-year follow-up. Seventy-five were primary surgical procedures; 53 were revisions. Data were collected from hospital charts, clinic notes, radiographs, and standardized questionnaires (Scoliosis Research Society-30 and Oswestry Disability Index). A total of 128 patients aged 37.6 ± 21 years underwent 518 PCOs (mean, 4.0 ± 2.2 yr) with 14.4 ± 3 mean instrumentation levels, with 3-year (range, 2-6.8 yr) average follow-up. PCOs were used for kyphosis correction in 49%, scoliosis correction at the apex of a curve in 13%, and both in 38%. One hundred six patients had complete radiographical data available for evaluation. Mean kyphosis correction per PCO was 8.8° ± 7.2°, varying with patient age (10.2° for those younger than 21 yr vs. 7.7° for those 21 yr or older, P < 0.0001) and region of the spine: thoracolumbar (T10-L2) 11.6°, lumbar (L2-S1) 9.4°, midthoracic (T6-T10) 7.2° and proximal thoracic (T1-T6) 3.6°. With PCOs at the apex of a curve, the maximum coronal Cobb decreased from 66° ± 21° to 31° ± 14° (P < 0.0001). Average estimated blood loss was 1419 ± 887 mL, correlating with greater age (P < 0.0001) and more instrumented levels (P < 0.0001), but not with the number of PCOs (P = 0.32). Complications occurred in 31 (24.2%) patients, including 4 radiculopathies (none attributable to PCOs). Complications did not correlate with the number of PCOs (P = 0.5). Six (4.7%) patients had loss of spinal cord monitoring or a failed wake-up test that could be attributed to overcorrection with PCOs, but none had postoperative deficits. Oswestry Disability Index scores improved (34.4 ± 17 to 23.6 ± 18, P < 0.0001), as did normalized Scoliosis Research Society-30 scores (63.7 ± 13 to 76.4 ± 15, P < 0.0001). Patients in this series undergoing posterior spinal fusion with PCOs achieved overall favorable outcomes for spinal deformity correction. The number of PCOs did not correlate with increased estimated blood loss or complications. The main technical concern was overcorrection, but neurological consequences associated with overcorrection were identified by intraoperative spinal cord monitoring and wake-up tests, and no patients experienced permanent neurological deficits related to PCOs. 4.

Severe idiopathic Knee arthrodesis scoliosis. Does the approach and the instruments used modify the results?

ObjectiveThe aim of this work is to evaluate and compare the radiographic results and complications of the surgical treatment in adolescents with idiopathic scoliosis greater than 75 degrees, using a double approach (DA) or an isolated posterior approach with hybrid instruments (posterior hybrid [PH]), or with “all-pedicle screws” (posterior screws [PS]). Materials and methodsA retrospective review was performed on 69 patients with idiopathic scoliosis greater than 75°, with a follow-up of more than 2 years, to analyze the flexibility of the curves, the correction obtained, and the complications depending on the type of surgery.The Kruskal–Wallis test for non-parametric variables was used for the statistical analysis. ResultsThere were no statistically significant differences between the 3 patient groups in the pre-surgical Cobb angle values (DA=89°, PH=83°, PS=83°), in the immediate post-surgical (DA=34°, PH=33°, PS=30°), nor at the end of follow-up (DA=36°, PH=36°, PS=33°) (P>.05). The percentage correction (DA=60%, PH=57%, PS=60%) was similar between groups (P>.05).The percentage of complications associated with the procedure was 20.8% in DA, 10% in PH and 20% in PS. Two patients in the PS group showed changes, with no neurological lesions, in the spinal cord monitoring, and one patient in the same group suffered a delayed and transient incomplete lesion. Discussion and conclusionsNo significant differences were observed in the correction of severe idiopathic scoliosis between patients operated using the double or isolated posterior approach, regardless of the type of instrumentation used.

Editorial: Use of intraoperative monitoring in children

The holy grail of intraoperative monitoring is accurate correlation of electrophysiological changes and postoperative neurological changes. Ideally, feedback provided to the surgeon in real time would allow for an alteration in technique and thus the opportunity to prevent or reverse neurological deficits. While intraoperative neuromonitoring modalities continue to evolve, the perfect predictive value of this tool remains elusive. Intraoperative spinal cord monitoring is essentially the standard of care for adults harboring intramedullary tumors.5–7 Less information is available in the pediatric population, perhaps given the rarity of these lesions.2–4 Cheng et al.1 report on their experience using both transcranial motor evoked potentials (TcMEPs) and somatosensory evoked potentials (SSEPs) in a retrospective series of 12 patients. Overall, they found that intraoperative electrical changes predicted postoperative neurological outcomes. They correlated changes in TcMEP and SSEP monitoring with specific intraoperative maneuvers, including traction on the spinal cord and tumor resection via the cavitational ultrasonic surgical aspirator. They also used dorsal column mapping to accurately predict where to perform a midline myelotomy, novel information in the pediatric population. Several patients in the series had intraoperative changes in their monitoring, which correlated with new postoperative deficits. Not all of these deficits resolved, and the correlation between intraoperative changes and postoperative dysfunction was not perfect. While the use of intraoperative monitoring in children undergoing intramedullary spinal cord tumor resection appears to be useful, the results of this study must be interpreted with some caution. The study is retrospective in nature with only 12 patients, 5 of whom did not undergo dorsal column mapping. Data were collected over a period of 8 years, and the last patient in the series underwent surgery a decade ago. Moreover, D-wave monitoring,8–10 a more recent advance in the intraoperative assessment of motor function, was not utilized. Nevertheless, the data contribute to our understanding of spinal cord tumor resection in the pediatric population. The authors noted that raising the blood pressure above normal was not helpful in reversing SSEP changes and that releasing traction proved the most reliable maneuver for correcting the first SSEP change. Finally, the provided data offer some guidance in the intraoperative balancing act faced by every surgeon regarding how aggressive the tumor resection should be to avoid tumor recurrence, while doing no harm in preserving neurological function. (http://thejns.org/doi/abs/10.3171/2013.9.PEDS13439)

Intraoperative Somatosensory Evoked Potential Monitoring Decreases EEG Burst Suppression Ratio During Deep General Anesthesia

The burst suppression (BS) EEG patterns induced by general anesthesia can react to somatosensory stimuli. We investigated this reactivity by studying the effect of peripheral nerve stimulation used for routine intraoperative spinal cord monitoring by somatosensory evoked potentials on BS patterns. The relative time spent in suppression expressed as BS ratio (BSR) and mean burst duration were measured before (BSR(Pre)), during (BSR(Stim)), and after (BSR(Post)) a 60-second repetitive electrical ulnar nerve stimulation in nine patients under total intravenous general anesthesia with propofol. The BS reactivity was measured as BSR(Pre)-BSR(Stim). Overall, 27 trials were included with BSR(Pre) up to 77%, indistinguishable from BSR(Post). During stimulation, the mean BSR transiently decreased from 42% to 35%. For each 1% increase in BSR(Pre), the BS reactivity increased with 0.6%, whereas the burst duration remained approximately 3 seconds. For BSR(Pre) below 30%, the BS reactivity was negligible. Data from this study show that somatosensory input can evoke bursts, altering the "spontaneous" deep BS patterns (BSR(Pre) >30%). Further studies are necessary to objectively assess the clinical relevance of stimulus-induced BS reactivity during deep general anesthesia.

Intraoperative Neurophysiological Changes Induced by Thoracic Pedicle Screws Intentionally Placed Within the Spinal Canal: An Experimental Study in Pigs

Study DesignExperimental study, ObjectivesTo document and analyze the neurophysiological changes during spinal cord monitoring when thoracic pedicle screws are intentionally placed within the spinal canal. Summary of Background DataAlthough the rate of misplaced screws is relatively high, few patients have neurological impairment. This suggests that a significant degree of medullary displacement and/or compression is necessary to produce neurophysiological changes. MethodsThe spinal cord of 3 experimental pigs was surgically exposed at 3 different levels (T11, T9, and T6). Two pedicle screws were placed within the spinal canal at each vertebral level under direct vision. One was placed on the lateral edge of the dural sac, causing only a slight cord displacement; a second screw was placed in the middle of the spinal canal, producing marked displacement of the neural structures. During the procedure, neurophysiological monitoring of the spinal cord was performed. ResultsNo neurophysiological changes were observed in any screws placed at the lateral edge of the dural sac for 20 minutes after screw placement. When the screws were placed in the center of the spinal canal, neurophysiological changes occurred with a mean latency of 10.1 ± 2.1 minutes, and at 11.6 ± 1.9 minutes there was complete loss of the spinal cord evoked potentials in all cases. After these centered screws were removed, evoked potentials began to recover, with a latency of 9.7 ± 3.0 minutes in 7 of 9 cases. ConclusionsNeurophysiological monitoring of the spinal cord does not detect moderate compression even 20 minutes after neural compression. Only thoracic pedicle screws provoking marked displacement of the spinal cord were able to cause delayed neurophysiological changes leading to loss of spinal cord evoked potentials, which in 22% of cases did not recover after the pedicle screw was removed.

Funnel plots and spine surgery: unit level and surgeon level outcome data

Funnel plots and spine surgery: unit level and surgeon level outcome data

Surgical correction of scoliosis in Rett syndrome: cord monitoring and complications

Rett syndrome is a progressive neurodevelopmental disorder that predominantly affects females and is associated with a high incidence of scoliosis and epilepsy. There is scant published work about intraoperative spinal cord monitoring in these patients and little more regarding the rate of perioperative complications. We investigated our institutions' experience with both. We retrospectively reviewed the records of 11 patients with Rett syndrome who underwent surgical correction of scoliosis at our institution between 2004 and 2010. Eleven patients underwent successful correction of their scoliosis at an average age of 12. Eight of the patients suffered one or more significant complications. The average curve was corrected from 71° to 27°. Successful spinal cord monitoring was achieved in eight of the nine patients where it was attempted. No patient suffered any neurological complications. Average inpatient stay was 18.2days. Scoliosis surgery in patients with Rett syndrome carries a very high rate of complications and an average hospital stay approaching 3 weeks. Both caregivers and surgeons should be aware of this when planning any intervention. These patients frequently have useful lower limb function and spinal cord monitoring is a valid tool to aid in its preservation. We would suggest aggressive optimisation of these patients prior to surgery, with an emphasis on nutrition.

Reviewer’s comment concerning “Calcified Giant Thoracic Disc Herniations—Considerations and Treatment Strategies” (DOI 10.1007/s00586-014-3210-5 by N.A. Quraishi et al.)

Thank you very much for asking me to review this paper [1]. I was particularly interested that some surgeons chose to use spinal cord monitoring whilst others did not.

Combined spinal arthrodesis with instrumentation for the management of progressive thoracolumbar kyphosis in children with mucopolysaccharidosis

To evaluate the outcome and complications of a novel technique for the treatment of progressive thoracolumbar kyphosis in children with mucopolysaccharidosis (MPS). The medical records and spinal imaging of four consecutive paediatric patients who underwent a single stage anteroposterior spinal fusion with segmental pedicle screw instrumentation were reviewed. Patients underwent spinal deformity correction at the mean age of 3 years (2.4-3.7) with mean clinical follow-up of 3.2 years (2.1-4.5) and mean postoperative radiographic follow-up was 2.4 years (0.8-3). Preoperative kyphosis was corrected from a mean angle of 65º (63º-70º) to 6.5º (-12º-13º). Vertebral subluxation at the apex of the deformity was corrected from an average 64% (56-83%) to 12% (0-24%). Spinal cord monitoring with somatosensory evoked potentials (SSEP) was successfully obtained and stable throughout surgery. No instrumentation failure, loss of correction or junctional problems occurred at final follow-up. Anterior and posterior spinal arthrodesis with segmental pedicle screw instrumentation is a safety and reliable technique for the treatment of severe thoracolumbar kyphosis in children with MPS. This technique achieves excellent correction of the deformity with adequate decompression of the spinal canal. The fusion is limited to the thoracolumbar junction and interferes minimally with the longitudinal growth of the thorax. No neurological complications or intraoperative spinal cord monitoring events occurred. No loss of correction or junctional kyphosis was observed.

Escoliosis idiopáticas graves. ¿El abordaje y la instrumentación modifican los resultados?

ObjectiveThe aim of this work is to evaluate and compare the radiographic results and complications of the surgical treatment of adolescents with idiopathic scoliosis greater than 75 degrees, using a double approach (DA) or an isolated posterior approach with hybrid instruments (posterior hybrid [PH]), or with «all-pedicle screws» (posterior screws [PS]). Material and methodA retrospective review was performed on 69 patients with idiopathic scoliosis greater than 75°, with a follow-up of more than 2 years, to analyze the flexibility of the curves, the correction obtained, and the complications depending on the type of surgery.The Kruskal-Wallis test for non-parametric variables was used for the statistical analysis. ResultsThere were no statistically significant differences between the 3 patient groups in the pre-surgical Cobb angle values (DA=89°, PH=83°, PS=83°), in the immediate post-surgical (DA=34°, PH=33°, PS=30°), nor at the end of follow-up (DA=36°, PH=36°, PS=33°) (P>.05). The percentage correction (DA=60%, PH=57%, PS=60%) was similar between groups (P>.05).The percentage of complications associated with the procedure was 20.8% in DA, 10% in PH and 20% in PS. Two patients in the PS group showed changes, with no neurological lesions, in the spinal cord monitoring, and one patient in the same group suffered a delayed and transient incomplete lesion. Discussion and conclusionsNo significant differences were observed in the correction of severe idiopathic scoliosis between patients operated using the double or isolated posterior approach, regardless of the type of instrumentation used.

A rare complication of tongue laceration following posterior spinal surgery using spinal cord monitoring: A case report.

A rare complication of tongue laceration following posterior spinal surgery using spinal cord monitoring: A case report.