Combination Monitoring Helps Avoid Kyphosis Complications

FRIDAY, May 9 (HealthDay News) -- The risk of neurologic deficit during surgery to correct pediatric kyphosis in the spinal cord region can be minimized by using multimodality monitoring and motor tract assessment during the procedure, according to research published in the May 1 issue of Spine.

Gene Cheh, M.D., of the Wooridul Spine Hospital in Seoul, Korea, and colleagues presented data from a review of 42 patients, average age 15, who underwent osteotomy at spinal cord levels for kyphotic deformity correction. Somatosensory sensory-evoked potential (SSEP) monitoring and neurogenic mixed-evoked potentials (NMEPs) were used for all patients.

The researchers report that nine patients (21.4 percent) had a total loss of NMEP data during the surgery, though SSEPs remained within acceptable limits. Intervention methods in this situation included elevating mean arterial pressure, releasing corrective forces or taking both of these steps. In all nine cases, NMEP data returned following the intervention within 20 minutes, the report indicates.

"Our results, again, point out that the NMEPs provide an early warning of impending neurologic deficit well before SSEPs have changed. Thus, it is imperative in these high-risk kyphotic correction cases to have a combination of multimodality and neurologic spinal cord monitoring including some type of motor tract monitoring. In no instance did we see the SSEP data change before the loss of NMEP data. Thus, using SSEPs alone, even with a wake-up test, may not provide the early warning necessary to avoid a real neurologic deficit after surgery," the authors write.

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