Importance of intraoperative dynamic spinal cord mapping (DSCM) during complex spinal deformity surgery
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CASE REPORT
Importance of intraoperative dynamic spinal cord mapping (DSCM) during complex spinal deformity surgery Fernando E. Silva1 · Lawrence Lenke1 Received: 3 February 2020 / Accepted: 11 May 2020 © Scoliosis Research Society 2020
Abstract Study design Case report and review of literature. Objective To illustrate the importance of “dynamic spinal cord mapping” (DSCM) in locating the site of neurophysiologic data loss during severe spinal deformity correction. Summary of background data During marked correction of severe spinal deformities, intra-operative neuromonitoring remains of paramount importance. This case illustrates the importance of a unique type of monitoring, particularly useful when obtaining correction at multiple sites. Methods A patient with symptomatic, progressive, severe kyphoscoliosis underwent multiple periapical posterior column osteotomies, partial T8 and complete T9 vertebral column resections and T2 to L3 posterior segmental instrumented fusion. During correction maneuvers, complete loss of spinous process descending neurogenic evoked potentials occurred. A flexible epidural catheter was placed at different spinal levels to dynamically stimulate the spinal cord and map out the site of data loss corresponding to the area of neural compromise. Results Using DSCM, the site of data loss was identified to the apex of the proximal thoracic region cephalad to the VCR site. This was rectified by releasing correction at the proximal end of the construct, and neurophysiologic data promptly returned to baseline. Postoperatively the patient was neurologically intact. Conclusion Dynamic spinal cord mapping helps map areas of neurophysiologic data loss permitting focused attention to the site of compromise to reverse the offending agent. This improves the chance for return of baseline data, avoiding the potential for permanent neurologic catastrophe for the patient. LOE IV. Keywords Spinal cord monitoring · Dynamic spinal cord mapping · Severe spinal deformity
Introduction Given the high risk for permanent neurologic deficits, treatment of complex spinal deformity requires spinal cord monitoring (SCM) [1]. This is particularly important when correcting severe kyphoscoliotic deformities via a posterior approach [2]. Methodologies of SCM rely on constant cortical or spinal cord stimulation monitoring for loss of neurophysiologic data. However, when such loss occurs, besides going thru the usual check list and maneuvers to try to recover the neurophysiologic data, including corroboration
* Lawrence Lenke [email protected] 1
of such loss with an alternative mode of stimulating, the site of neuroelement compromise must be located if neurophysiologic data loss persists [3]. Current SCM can detect acute neurophysiologic data loss but does not accurately localize the loss. Similar to localizing the motor cortex during brain surgery via wave phase reversal, “dynamic spinal cord mapping” (DSCM) remedies this shortcoming [4]. Although similar to its use on the motor cortex, this spinal c
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