Our Summary

This research paper presents a case where a patient with a specific type of spine curvature (type 3 thoracolumbar scoliosis) was scheduled for a complex spinal surgery. During the surgery, doctors use special techniques to monitor the patient’s nervous system to make sure it’s not being damaged. However, in this case, the monitoring showed that the patient was losing nerve signals in their right leg even before the actual surgery began. The patient also showed signs of weakness in the right leg, which led the doctors to stop the surgery. When the doctors attempted the surgery again, the same issue arose. The surgery was halted again and the patient woke up with no disability. This case highlights that these nerve signal changes can happen very early on, especially in more delicate cases, and doctors need to keep an eye on this to avoid causing disability in the patient.

FAQs

  1. What are somatosensory-evoked potential and motor-evoked potential?
  2. Why was the scoliosis surgery stopped for the patient with type 3 thoracolumbar scoliosis?
  3. How can changes in motor-evoked potentials impact the outcome of a scoliosis surgery?

Doctor’s Tip

A doctor may advise a patient undergoing scoliosis surgery to be aware of the potential risks associated with neuromonitoring changes, such as loss of signal in the lower limbs. It is important for patients to communicate any symptoms of weakness or changes in sensation to their medical team during the surgery to ensure the best possible outcome.

Suitable For

Patients who are typically recommended scoliosis surgery are those with severe curvature of the spine (typically greater than 40-50 degrees), progressive worsening of the curvature, significant pain or discomfort, difficulty breathing due to the curvature, and neurological symptoms such as weakness or numbness in the limbs. Patients with neuromuscular scoliosis, congenital scoliosis, or other underlying conditions that are causing the curvature may also be recommended for surgery. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if surgery is the best treatment option for their specific case.

Timeline

Before scoliosis surgery:

  1. Patient is diagnosed with scoliosis, a condition characterized by an abnormal lateral curvature of the spine.
  2. Patient undergoes preoperative evaluations, including physical exams, imaging studies, and possibly neurological assessments.
  3. Surgical plan is developed by the medical team, including the type of surgery to be performed (e.g., spinal fusion, instrumentation).
  4. Intraoperative monitoring techniques, such as somatosensory-evoked potential and motor-evoked potential, are discussed and planned for to ensure neurological integrity during surgery.

After scoliosis surgery:

  1. Patient is brought into the operating room and positioned for surgery.
  2. Anesthesia is administered and the surgical team begins the procedure.
  3. Intraoperative monitoring is initiated to assess the patient’s neurological status during the surgery.
  4. In the case of the patient with type 3 thoracolumbar scoliosis, loss of signal in the neuromonitoring over the right lower limb is detected in the exposure stage, prompting the surgical team to stop the procedure.
  5. Surgery is abandoned due to the risk of neurological damage, and the patient wakes up without disability.
  6. A second attempt at surgery is made, but the same abnormality in the monitoring is present, leading to the surgery being aborted once again.
  7. The patient’s neurological function is preserved, and further interventions may be considered to address the scoliosis without risking neurological complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with scoliosis surgery?
  2. How long is the recovery period after scoliosis surgery?
  3. What type of scoliosis surgery would be most appropriate for my specific condition?
  4. How will the surgery impact my daily activities and quality of life?
  5. What are the success rates of scoliosis surgery in terms of correcting spinal curvature?
  6. Will I need any additional treatments or therapies after the surgery?
  7. How experienced is the surgical team in performing scoliosis surgeries?
  8. What type of anesthesia will be used during the surgery?
  9. How long will the surgery take and what can I expect during the procedure?
  10. Are there any alternative treatment options to consider before undergoing surgery?

Reference

Authors: Vijay V, Thomas A, Menon SK. Journal: Neurol India. 2022 Jan-Feb;70(1):363-365. doi: 10.4103/0028-3886.338722. PMID: 35263915