Abstract
To establish the current practice of spinal cord monitoring in units carrying out scoliosis surgery in the UK.
To illustrate the benefit of routinely monitoring motor evoked potentials (MEPs).
Questionaire: Nationwide survey of spinal monitoring modalities used by spinal units carrying out deformity surgery.
10 out of 27 units routinely measure motor evoked potentials (MEPs), the remainder use only sensory potentials (SEPs). There is significant variability in use of monitoring around the UK and we have compared this to the practice elsewhere in the world.
We report the case of a thirteen year old girl who underwent posterior instrumentation for correction of an idiopathic scoliosis. Intra-operatively there was a significant reduction in the amplitude of the MEPs without any corresponding change in the SEPs. These changes reversed when the correction was released. The surgery was abandoned and was carried out as a staged procedure, initially anteriorly then posteriorly. There was no loss of motor potentials during either operation and no post operative neurological abnormalities.
We propose that the changes noted initially were due to transient ischaemia of the cord which would not have been detected without MEPs and may have led to long term sequelae. This highlights the safety benefit of routinely using MEPs in scoliosis surgery.
Nationally there is wide variation in the monitoring of spinal cord function during scoliosis surgery. We feel that monitoring of motor potentials is a vital component in ensuring scoliosis surgery is as safe as possible.
