Our Summary

This study looked at the use of neuromonitoring techniques in scoliosis surgeries. Scoliosis is a condition where the spine curves to one side, and these surgeries aim to correct that. The researchers used two types of neuromonitoring: somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (TcMEP). These techniques involve stimulating nerves and recording the responses to assess the function of the nervous system during surgery.

The study involved 52 patients who had scoliosis surgery between 2013 and 2015. The researchers found that this method of monitoring was effective in increasing safety during surgery, with no instances of missed problems (false negatives). However, there were some false positives, cases where the monitoring indicated a problem when there wasn’t one. These were due to low blood pressure and issues with the leads used to monitor the nerves.

The researchers suggest that using leads on the upper limbs could help reduce these false positives. They also found that patients with neuromuscular scoliosis (caused by problems with the nerves and muscles) had lower baseline values than those with idiopathic scoliosis (where the cause is unknown), meaning that any changes during surgery should be read with caution.

FAQs

  1. What are somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (TcMEP) used for in scoliosis surgery?
  2. What were the main findings of the study on neuromonitoring techniques in scoliosis surgeries between 2013 and 2015?
  3. How can false positives during neuromonitoring in scoliosis surgery be reduced?

Doctor’s Tip

Overall, the use of neuromonitoring techniques during scoliosis surgery can help increase safety and reduce the risk of nerve damage. However, it is important for patients to be aware of the potential for false positives and to discuss any concerns with their surgical team. Following post-operative instructions and attending follow-up appointments are also crucial for a successful recovery.

Suitable For

Patients who are typically recommended scoliosis surgery are those who have severe curvature of the spine that is causing pain, difficulty breathing, or other complications. Additionally, patients who have not responded to other non-surgical treatments such as bracing or physical therapy may be recommended for surgery. Patients with neuromuscular scoliosis, such as those with conditions like cerebral palsy or muscular dystrophy, may also be recommended for surgery to prevent further progression of the curvature.

Timeline

Before scoliosis surgery, a patient typically undergoes a series of evaluations including physical exams, imaging tests (such as X-rays or MRI), and possibly non-surgical treatments like bracing or physical therapy. The patient will also meet with the surgical team to discuss the procedure, potential risks, and recovery process.

During scoliosis surgery, the patient is placed under general anesthesia and the surgeon makes incisions to access the spine. The surgeon then performs the necessary corrections to straighten the spine, which may involve the use of rods, screws, or other implants. Neuromonitoring techniques like SSEP and TcMEP are used to monitor the function of the nervous system and ensure that no damage is done to the spinal cord or nerves during the surgery.

After scoliosis surgery, the patient is monitored closely in the recovery room before being transferred to a hospital room. Pain management techniques are used to keep the patient comfortable, and physical therapy may be initiated to help with mobility and strength. The patient will typically stay in the hospital for a few days before being discharged, with follow-up appointments scheduled to monitor healing and recovery.

Overall, scoliosis surgery can be a complex and challenging procedure, but with the use of advanced techniques like neuromonitoring, the safety and success rates of the surgery can be improved. It is important for patients to work closely with their healthcare team throughout the process to achieve the best possible outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about scoliosis surgery include:

  1. What are the potential risks and complications associated with scoliosis surgery?
  2. How long is the recovery process after scoliosis surgery?
  3. Will I need physical therapy or other forms of rehabilitation after surgery?
  4. What type of scoliosis surgery is recommended for my specific condition?
  5. How long will the surgery take and what is the expected outcome?
  6. Will I need to restrict my activities or make lifestyle changes after surgery?
  7. What is the success rate of scoliosis surgery in terms of correcting the curvature of the spine?
  8. Are there any alternative treatments to surgery that I should consider?
  9. How often will I need to follow up with my doctor after surgery?
  10. What type of anesthesia will be used during the surgery and are there any risks associated with it?

Reference

Authors: Krishnakumar R, Srivatsa N. Journal: Neurol India. 2017 Jan-Feb;65(1):75-79. doi: 10.4103/0028-3886.198189. PMID: 28084243