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Tag: adolescence|article link|deformity correction|Scoliosis|skull

Neurophysiological Changes in Deformity Correction of Adolescence Idiopathic Scoliosis with Intraoperative Skull-Femoral Traction.

By wp_zaman

Neurophysiological Changes in Deformity Correction of Adolescence Idiopathic Scoliosis with Intraoperative Skull-Femoral Traction.

Spine (Phila Pa 1976). 2011 Feb 25;

Authors: Lewis SJ, Gray R, Holmes L, Strantzas S, Jhaveri S, Zaarour C, Magana S

ABSTRACT: Study design: Retrospective review of 36 consecutive patients undergoing coronal plane deformity correction with intra-operative skull-femoral traction between 2005 and 2008 with MEP/SSEP monitoring.Objective: To determine the prevalence and significance of neurophysiological changes with intraoperative skull-femoral traction in AIS.Summary of Background Data: Intra-operative skeletal traction can be associated with spinal cord stretching and ischemia with resultant electrophysiological changes. The prevalence and risks of such changes and their clinical significance is unknown.Methods: 37 procedures involving 36 patients (27 females and 9 males) with a mean age of 14.8(12 – 18) years were divided into two groups based on the presence (Group 1, n = 18 procedures) or absence (Group 2, n = 19) of significant MEP changes with surgery. They were compared to patients undergoing correction without traction (Group 3).Results: Significant differences among the groups was observed in mean pre-operative Cobb (86° vs 70° vs.59º), mean intra-operative post-traction Cobb angle (50.0° vs 34.6°), traction index (0.41 vs 0.50), flexibility index (0.14 vs 0.27 vs 0.25), and presence of primary lumbar curves (0% vs 32% vs 14%). Initial onset of MEP amplitude loss (Group 1) occurred at a mean of 94 min (1-257) from the onset of surgery, was bilateral in 13 procedures, and improved at a mean of 5.5 min (1-29) after decreasing or removing the traction. At closure, complete bilateral recovery to baseline was observed in 10 procedures, recovery to > 50% baseline in 5, and recovery to < 50% baseline in 3 procedures. There were no neurologic deficits in this series.Conclusions: Intra-operative traction is associated with frequent changes in MEP monitoring. The thoracic location of the major curve, increasing Cobb angle, and rigidity of major curve are significant risk factors for changes in MEP with traction. The presence of any MEP recordings irrespective of its amplitude at closure was associated with normal neurological function. SSEP monitoring did not correlate with the traction induced MEP amplitude changes.

PMID: 21358570 [PubMed – as supplied by publisher]