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

Clinical Neurophysiology Practice, 2022 · DOI: https://doi.org/10.1016/j.cnp.2022.11.001 · Published: November 14, 2022

Simple Explanation

Prone positioning during spinal surgery can be risky for the nervous system. This risk can be mitigated using intraoperative neurophysiological monitoring (IONM). This case report highlights the importance of IONM in detecting neurological complications related to patient positioning during scoliosis correction. A 3-year-old child with kyphoscoliosis underwent scoliosis treatment. During the procedure, the child experienced a loss of lower limb somatosensory and motor responses, which were detected by IONM. Repositioning the patient resolved the issue, and the surgery was completed without postoperative neurological deficits. The findings suggest that neuromonitoring should be used during anesthesia induction and patient positioning in corrective spinal deformity surgery. IONM helps to detect and prevent potential spinal cord injuries during these early phases of surgery.

Study Duration

Not specified

Participants

A 3-year-old child

Evidence Level

Case report

Key Findings

1
IONM is valuable in detecting spinal positioning-related neurological complications during kyphoscoliosis correction. The case highlights how IONM can identify issues arising from patient positioning before surgical maneuvers.
2
Loss of lower limb somatosensory and motor responses was detected during prone positioning. This was resolved by repositioning the patient, demonstrating the sensitivity of IONM to positioning-related issues.
3
The study reinforces the importance of extending neuromonitoring to the early phases of anesthesia induction and patient positioning, ensuring early detection and correction of potential neurological complications.

Research Summary

This case report emphasizes the importance of intraoperative neurophysiological monitoring (IONM) in detecting spinal positioning-related neurological complications during kyphoscoliosis correction in a 3-year-old child. The patient experienced a loss of lower limb somatosensory and motor responses during prone positioning, which was detected by IONM. Repositioning the patient led to the recovery of these responses and allowed the surgery to be completed without postoperative deficits. The findings suggest that neuromonitoring should be extended to the early phases of anesthesia induction and patient positioning during corrective spinal deformity surgery to ensure early detection and prevention of potential spinal cord injuries.

Practical Implications

Improved Patient Safety

Implementing IONM during patient positioning can help prevent neurological deficits by allowing for early detection and correction of positioning-related issues.

Enhanced Surgical Planning

IONM can guide surgical teams in optimizing patient positioning to minimize the risk of spinal cord injury.

Refined Monitoring Protocols

The case underscores the need for protocols that include monitoring during all phases of surgery, including anesthesia induction and positioning.

Study Limitations

1
Single case report limits generalizability
2
The specific cause of the initial signal loss is multifactorial and difficult to isolate
3
Lack of a control group

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