Our Summary
This research paper is a review of various techniques used to monitor the nervous system during spinal deformity surgery. The goal is to provide a comprehensive understanding of these techniques, focusing on two specific ones: neurogenic motor-evoked potentials and descending neurogenic evoked potentials.
The paper explains that the original method of monitoring, the Stagnara wake-up test, is still considered the best at detecting actual neurological issues. However, more recent techniques have been developed and widely used. These include somatosensory evoked potentials, which measure signals from the body to the brain, and motor evoked potentials, which measure muscle activity after the brain is stimulated. However, these methods have certain limitations.
For instance, somatosensory evoked potentials may be delayed, poorly localized, and unable to detect damage to motor tracts. On the other hand, motor evoked potentials can be challenging to interpret in patients with pre-existing motor disorders and cannot be continuously monitored.
Newer techniques such as descending neurogenic evoked potentials and neurogenic motor evoked potentials are being used at some specialized centers. The authors conclude that a solid understanding of the history and physiological systems used for these monitoring techniques can help spine surgeons choose the most suitable method for their patients.
FAQs
- What are the two specific techniques for monitoring the nervous system during spinal deformity surgery that this paper focuses on?
- What are the limitations of the somatosensory evoked potentials and motor evoked potentials methods?
- What does the paper suggest for spine surgeons in choosing the most suitable monitoring technique for their patients?
Doctor’s Tip
A doctor might tell a patient undergoing pediatric scoliosis surgery that monitoring techniques such as neurogenic motor-evoked potentials and descending neurogenic evoked potentials are used to ensure the safety of the nervous system during the procedure. These techniques help the surgical team monitor the function of the spinal cord and nerves in real-time, reducing the risk of neurological complications. It is important for the patient to follow post-operative care instructions carefully to promote healing and prevent complications.
Suitable For
Patients who are typically recommended for pediatric scoliosis surgery are those with severe curvature of the spine that is causing pain, difficulty breathing, or other complications. Additionally, patients who have not responded to non-surgical treatments such as bracing or physical therapy may also be candidates for surgery. The decision to recommend surgery is typically made by a team of healthcare professionals including orthopedic surgeons, pediatricians, and physical therapists, taking into consideration the individual patient’s age, overall health, and the severity of their scoliosis.
Timeline
Before pediatric scoliosis surgery, a patient will typically undergo a series of tests and examinations to determine the severity of their condition and the best course of treatment. This may include physical exams, imaging tests such as X-rays or MRI scans, and possibly bracing or physical therapy to try to correct the curve of the spine.
Once it is determined that surgery is necessary, the patient and their family will meet with the surgical team to discuss the procedure, potential risks and benefits, and what to expect during the recovery process. The patient may also undergo pre-operative testing to ensure they are healthy enough for surgery.
During the surgery itself, the patient will be placed under general anesthesia and the surgical team will work to correct the curve of the spine using techniques such as spinal fusion or instrumentation. Throughout the surgery, various monitoring techniques such as neurogenic motor-evoked potentials and descending neurogenic evoked potentials may be used to ensure the safety of the nervous system.
After surgery, the patient will typically spend a few days in the hospital for recovery and pain management. Physical therapy may be recommended to help regain strength and mobility in the spine. Follow-up appointments will be scheduled to monitor the progress of the patient’s recovery and to address any concerns or complications that may arise.
Overall, the timeline for a patient before and after pediatric scoliosis surgery involves a thorough evaluation, preparation, surgery, recovery, and ongoing follow-up care to ensure the best possible outcome for the patient.
What to Ask Your Doctor
Some questions a patient should ask their doctor about pediatric scoliosis surgery may include:
- What are the potential risks and complications associated with scoliosis surgery in children?
- What is the success rate of pediatric scoliosis surgery in terms of correcting spinal deformity?
- How long is the recovery process for pediatric scoliosis surgery, and what kind of post-operative care will be needed?
- What type of monitoring techniques will be used during the surgery to ensure the safety of the nervous system?
- How experienced is the surgical team in performing pediatric scoliosis surgery, and what is their success rate?
- Are there any alternative treatment options for pediatric scoliosis that should be considered before surgery?
- What are the long-term effects and outcomes of pediatric scoliosis surgery?
- How will the surgery impact the child’s growth and development in the future?
- What kind of physical therapy or rehabilitation will be needed after pediatric scoliosis surgery?
- Are there any lifestyle changes or restrictions that the child will need to follow after surgery?
By asking these questions, the patient can gain a better understanding of the surgical process, potential outcomes, and necessary precautions to take before and after the surgery.
Reference
Authors: Strike SA, Hassanzadeh H, Jain A, Kebaish KM, Njoku DB, Becker D, Ain MC, Sponseller PD. Journal: Clin Spine Surg. 2017 Nov;30(9):E1174-E1181. doi: 10.1097/BSD.0000000000000388. PMID: 27231831