Neural Complications of Surgical Treatment of Adolescent Idiopathic Scoliosis: a Single Center Experience
|Filipa Pereira1, Paula Sá1, Daniel Soares1, Luis Dias2, Joana Gomes Dias3, António Oliveira2, Humberto Machado1*|
|1Serviço de Anestesiologia, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal|
|2Serviço de Ortopedia e Traumatologia, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal|
|3Departamento de Saúde Pública, Administração Regional do Norte, Porto, Portugal|
|Corresponding Author :||Humberto Machado
Serviço de Anestesiologia, Centro Hospitalar do Porto
Largo Professor Abel Salazar
4099-001 Porto, Portugal
Tel: +351 935848475
E-mail: [email protected]
|Received: October 05, 2015 Accepted: January 20, 2016 Published: January 26, 2016|
|Citation: Pereira F, Sa P, Soares D, Dias L, Dias JG, et al. (2016) Neural Complications of Surgical Treatment of Adolescent Idiopathic Scoliosis: a Single Center Experience. J Anesth Clin Res 7:596. doi:10.4172/2155-6148.1000596|
|Copyright: © 2016 Pereira F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Objective: Adolescent idiopathic scoliosis surgery presents a challenge to anesthetist due to the extensive nature of the surgery and the constraints on anesthetic techniques of intraoperative neurophysiological monitoring of the spinal cord. Intraoperative neurophysiological monitoring combining both somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) have become a standard of care by preventing neurologic sequela and lesions of the spinal cord. The objective of this article was to assess the incidence of neural complications in surgical treatment of adolescent idiopathic scoliosis surgery in a single institution and investigate possible factors associated with it.
Methods: Medical records of 216 patients who underwent adolescent idiopathic scoliosis surgery with posterior spinal fusion were retrospectively reviewed from January 2009 to October 2013. Patients were monitored using electrophysiological methods including SSEPs and transcranial electric MEPs simultaneously.
Results: Neurophysiologic monitoring changes were seen in 5 patients (2.3%): 4 (75%) women and 1 (25%) men. Out of the 5 patients with significant signal alert, 3 patients presented changes in Tc-MEPs and 2 patients in Tc-MEPs and SSEPs. 3 patients presented intraoperative significant changes in neurophysiologic signals that improved following corrective actions by surgeons and correction of hemodynamic parameters by anesthesiologists with no postoperative neurologic deficits; 2 did not show any reversal of the signals after systemic intervention and developed postoperative neurologic deficits consisting of transient paraparesis (0.92%).
Conclusion: This study indicates that early detection of neurophysiological changes using a multimodal approach with SSEPs and Tc-MEPs affords the surgical team an opportunity to perform rapid intervention to prevent injury progression or the possibility to reverse impeding neurologic sequela.