The value of intraoperative neurophysiological monitoring during positioning in pediatric scoliosis correction: A case report

• Published in: Clinical neurophysiology practice 2022-01, Vol.7, p.366-371
• Main Authors: Cavinato, M., Vittoria, F., Piccione, F., Masiero, S., Carbone, M.
• Format: Article
• Language: English
• Subjects: Case report; Clinical and; Intraoperative neurophysiological monitoring; Prone position; Scoliosis; Spine surgery
• ISSN: 2467-981X; 2467-981X
• DOI: 10.1016/j.cnp.2022.11.001

•Malpositioning during spine surgery can cause post-operative neurological complications.•IONM is effective for surveillance and prevention of neurological injuries.•IONM represents a guide during positioning to prevent neurological risks during spine surgery. Prone position during posterior spine surgery can represent a potentially risky procedure for the nervous system. Infrequent injuries due to prone positioning consist of subtle spinal cord infarction or myelopathy that can be promptly detected by intraoperative neurophysiological monitoring (IONM), if applied in this phase of surgery. Here, we report a case that stresses the value of IONM even in detecting spinal positioning-related neurological complications during kyphoscoliosis correction. A 3-year-old child with a severe thoracic kyphoscoliosis with the angle in the tract T5-T6 underwent an early treatment of scoliosis with growing rods. Before instrumentation or the reduction maneuver, lower limb somatosensory and motor responses disappeared. The patient was repositioned with neck and chest in a more protective position and neuromonitoring signals returned to baseline. The surgery could be completed and the patient had no postoperative neurologic or vascular deficits. Our findings suggest the importance of extending neuromonitoring in the early phases of anesthesia induction and patient positioning during corrective spinal deformity surgery.