Our Summary

This research paper looks at the role of neurophysiologic monitoring during surgeries to correct spinal deformities. This kind of monitoring helps prevent nerve damage during surgery. The study looked at patients who had this type of surgery in a West African hospital over one year. The research identified what caused nerve damage during surgery and what this meant for patients after their operations.

The patients in the study were aged between 3 and 28, with severe spinal deformities. The researchers found that a number of surgical procedures caused nerve damage. The most common causes were the way the patient was positioned or moved during surgery, the surgical procedure itself, and the placement of implants.

The study found that when the cause of the nerve damage was identified and corrected during surgery, there was a very low risk of long-term nerve damage. However, certain surgical procedures (osteotomies), which involve removing or reshaping part of the bone, resulted in irreversible nerve damage.

At a 6-week follow-up, all patients had some movement and the ability to walk, though some had not fully recovered. The study concluded that while neurophysiologic monitoring can help prevent nerve damage during spinal deformity surgery, some surgical procedures carry a high risk of irreversible nerve damage.

FAQs

  1. What is the role of neurophysiologic monitoring during surgeries to correct spinal deformities?
  2. What were the most common causes of nerve damage during the surgical procedures in the study?
  3. What was the impact of identifying and correcting the cause of nerve damage during surgery on the risk of long-term nerve damage?

Doctor’s Tip

One helpful tip a doctor might give a patient about spinal surgery is to carefully follow post-operative instructions, including physical therapy exercises and restrictions on certain activities. This can help ensure proper healing and prevent complications. Additionally, maintaining a healthy lifestyle, including regular exercise and proper nutrition, can aid in the recovery process and overall spine health. Lastly, communicating openly with your healthcare team about any concerns or changes in symptoms is essential for monitoring progress and addressing any issues that may arise.

Suitable For

Patients who are typically recommended for spinal surgery are those with severe spinal deformities, such as scoliosis or kyphosis, that are causing significant pain, difficulty moving, or affecting their quality of life. These patients may have tried other non-surgical treatments, such as physical therapy or medication, without success. Additionally, patients with spinal tumors, spinal cord injuries, or degenerative disc disease may also be recommended for spinal surgery to alleviate symptoms and improve function.

Timeline

Before spinal surgery:

  • Patient is evaluated by a medical professional and undergoes diagnostic tests to determine the severity of their spinal deformity.
  • Patient is informed about the risks and benefits of surgery and the expected outcomes.
  • Patient may undergo pre-operative physical therapy to strengthen muscles and improve mobility.
  • Patient is given pre-operative instructions, including fasting before surgery and stopping certain medications.
  • Patient undergoes spinal surgery, with neurophysiologic monitoring used to prevent nerve damage during the procedure.

After spinal surgery:

  • Patient is closely monitored in the post-anesthesia care unit to ensure they are stable.
  • Patient may experience pain and discomfort after surgery, which is managed with pain medications.
  • Patient begins physical therapy to regain strength and mobility in the affected area.
  • Patient is discharged from the hospital once they are deemed stable and able to care for themselves at home.
  • Patient attends follow-up appointments with their surgeon to monitor their progress and address any concerns.
  • Patient gradually resumes daily activities and may eventually return to work or school, depending on their recovery progress.

Overall, the timeline for a patient before and after spinal surgery involves thorough evaluation, careful preparation, and ongoing support to ensure a successful recovery and improved quality of life.

What to Ask Your Doctor

  1. What specific surgical procedure is recommended for my spinal deformity and what are the potential risks and benefits associated with it?
  2. Will neurophysiologic monitoring be used during my surgery to prevent nerve damage?
  3. What are the potential causes of nerve damage during spinal surgery and how will they be minimized during my operation?
  4. How will my positioning during surgery impact the risk of nerve damage, and what steps will be taken to ensure my safety?
  5. What is the expected recovery process after spinal surgery, and what are the chances of experiencing long-term nerve damage?
  6. How many surgeries of this type have you performed, and what is your success rate in preventing nerve damage?
  7. Are there alternative treatment options for my spinal deformity that do not carry the same risk of nerve damage?
  8. What post-operative rehabilitation plan will be recommended to help me regain movement and function after surgery?
  9. How often will follow-up appointments be scheduled to monitor my progress and address any potential complications?
  10. Are there any specific lifestyle changes or precautions I should take after spinal surgery to protect against nerve damage in the future?

Reference

Authors: Bjerke BT, Zuchelli DM, Nemani VM, Emerson RG, Kim HJ, Boachie-Adjei O. Journal: Spine Deform. 2017 Mar;5(2):117-123. doi: 10.1016/j.jspd.2016.11.002. PMID: 28259263