Rocos Brett, Wong Ian H, Jentzsch Thorsten, Strantzas Samuel, Lewis Stephen J
Orthopaedic Surgery, Duke University, Durham, USA.
Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, Toronto, CAN.
Cureus. 2024 Apr 30;16(4):e59353. doi: 10.7759/cureus.59353. eCollection 2024 Apr.
The correction of anemia is important in reversing significant intraoperative bilateral motor-evoked potential (MEP) loss following rod placement for correction of large scoliosis curves. This article presents a retrospective review of intraoperative neuromonitoring (IONM) data, anesthesia records, and medical charts of two patients with significant bilateral MEP changes associated with posterior spinal surgery for deformity correction. A 70 kg 12-year-old and a 44 kg 16-year-old female with main thoracic curves underwent a posterior scoliosis correction with multilevel posterior column osteotomies. Following rod insertion, significant reduction in the bilateral lower extremity MEP occurred in both cases despite mean arterial pressure exceeding 70 mmHg, which was presumed to be due to the scale of the correction attempted in the setting of haemorrhage which rendered the patient acutely anaemic, thus compromising cord vasculature and oxygen delivery. The rods were removed and packed red blood cell transfusions were administered in response to acute anaemia as a result of haemorrhage in both cases. Neither was noted to be anaemic preoperatively. Once the MEP signals improved, the rods were reinserted and correction was attempted, limited by neuromonitoring signals and resistance of the bony anchors to pullout. At closure, the MEPs were near baseline in the first case and >50% of baseline in the second. There were no changes in the somatosensory evoked potential signals in either case. Post-operative neurological function was normal in both patients. Correcting the circulating haemoglobin concentration through blood product resuscitation allowed for safe correction of spinal deformity in two cases with significant bilateral MEP loss following the initial placement of rods.
在为矫正大型脊柱侧弯曲线而置入棒材后，纠正贫血对于逆转术中显著的双侧运动诱发电位（MEP）损失至关重要。本文回顾性分析了两名因脊柱后路手术矫正畸形而出现显著双侧MEP变化患者的术中神经监测（IONM）数据、麻醉记录和病历。一名70公斤的12岁女性和一名44公斤的16岁女性，均为胸椎主弯，接受了后路脊柱侧弯矫正及多级后柱截骨术。置入棒材后，尽管平均动脉压超过70 mmHg，但两例患者双侧下肢MEP均显著降低，推测这是由于在出血情况下进行的矫正规模较大，导致患者急性贫血，从而影响了脊髓血管系统和氧气输送。两例均因出血导致急性贫血而取出棒材并输注浓缩红细胞。术前两人均无贫血。一旦MEP信号改善，便重新置入棒材并尝试矫正，但受神经监测信号和骨锚抗拔出阻力的限制。缝合时，第一例患者的MEP接近基线，第二例患者的MEP大于基线的50%。两例患者的体感诱发电位信号均未发生变化。两名患者术后神经功能均正常。通过血液制品复苏纠正循环血红蛋白浓度，使得两例在初次置入棒材后出现显著双侧MEP损失的患者能够安全地矫正脊柱畸形。
