Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham, UK.
Eur Spine J. 2013 Mar;22 Suppl 1(Suppl 1):S38-41. doi: 10.1007/s00586-012-2652-x. Epub 2013 Jan 24.
Patients with neuromuscular scoliosis are at increased risk of neurological deficit post-operatively, but are a difficult population on whom to perform neurophysiological monitoring. We look here at a 7-year sample of our practice in the monitoring of neuromuscular patients.
A retrospective chart review was performed for 109 patients who underwent correction of neuromuscular scoliosis within our institution between 2005 and 2011.
Of 109 patients who were identified, intraoperative monitoring was attempted in 66 cases. In eight cases (13 %), no reliable monitoring could be achieved and was therefore abandoned. On nine occasions, there was a significant drop in at least one modality intraoperatively. None of these nine suffered any clinically observable neurological deficit post-operatively. Of the 109 patients, 2 had clinically detectable deficits post-operatively, both of whom had undergone normal intraoperative monitoring.
The two patients with observable deficit had their instrumentation left in situ after discussion with them and/or parents. Spinal cord monitoring in this population is possible but potentially unreliable. Surgeons will need to carefully consider the use of monitoring in their management of this challenging population.
神经肌肉型脊柱侧凸患者术后有发生神经功能缺损的风险增加，但对这类患者进行神经生理监测存在困难。我们在此回顾了我们机构在 2005 年至 2011 年间对神经肌肉型患者进行监测的 7 年实践经验。
对 2005 年至 2011 年间在我们机构接受神经肌肉型脊柱侧凸矫正手术的 109 例患者进行回顾性图表审查。
在所确定的 109 例患者中，有 66 例尝试了术中监测。在 8 例（13%）中，无法获得可靠的监测，因此放弃了监测。在 9 例中，至少有一种监测方式在术中出现明显下降。这 9 例患者均未出现任何可观察到的术后神经功能缺损。在 109 例患者中，有 2 例患者术后出现可观察到的神经功能缺损，而这 2 例患者的术中监测均正常。
这两名出现明显神经功能缺损的患者，经过与他们及其父母讨论后，决定将器械留在原处。在这类人群中，脊髓监测是可行的，但可能不可靠。外科医生需要仔细考虑在管理这一具有挑战性的患者群体时是否使用监测。
