Neurophysiologic intraoperative monitoring (NIOM) in pediatric patients with polyneuropathy
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ORIGINAL ARTICLE
Neurophysiologic intraoperative monitoring (NIOM) in pediatric patients with polyneuropathy Jennifer L. McKinney 1,2
&
Monica P. Islam 1,2
Received: 18 December 2019 / Accepted: 6 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Neurophysiologic intraoperative monitoring (NIOM) abnormalities during scoliosis surgery led to a diagnosis of Friedreich’s ataxia in this illustrative case. This prompted the retrospective examination of NIOM for pediatric scoliosis surgery in polyneuropathy patients. Methods Among patients who underwent scoliosis surgery in 2010–2017, there were six polyneuropathy patients identified. Their clinical history and baseline NIOM data were reviewed. Results Scoliosis accompanied Charcot–Marie–Tooth disease, Friedreich’s ataxia, and ataxia telangiectasia. Some patients with no recorded somatosensory evoked potentials (SEPs) exhibited motor evoked potentials (MEPs); no patients with absent MEPs had SEPs present. NIOM modifications included SEP stimulation rate; type of SEP electrodes used; train parameters for MEP acquisition; and sweep speed. Conclusions This sample of NIOM data for previously monitored scoliosis cases in children with polyneuropathy allowed investigation of patterns of findings and troubleshooting attempts to optimize monitoring. Attentiveness to pertinent medical history prepared the NIOM team to change typical recording parameters based on underlying polyneuropathy. A multimodality approach provided useful information as several of these cases would have been unmonitorable with use of SEPs alone. As for the case described, the awareness of NIOM patterns in polyneuropathy may guide evaluations of patients with presumed idiopathic scoliosis who have unrecognized polyneuropathy. Keywords Neurophysiologic intraoperative monitoring (NIOM) . Polyneuropathy . Scoliosis . Charcot–Marie–Tooth disease . Friedreich’s ataxia
Introduction This study examines parameters of a multimodality approach to neurophysiologic intraoperative monitoring (NIOM) for patients with polyneuropathy undergoing corrective surgery for scoliosis. Pediatric patients may develop scoliosis, often during periods of increased growth, and those with polyneuropathy are at higher risk. For example, patients with Charcot–Marie–Tooth (CMT) disease, the prototypic
* Jennifer L. McKinney [email protected] 1
Division of Neurology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
2
Department of Clinical Pediatrics, Section of Neurology, The Ohio State University, Columbus, OH, USA
inherited polyneuropathy, have a significant risk of developing spinal deformity with a reported incidence of 26–37% [3] while the overall prevalence of adolescent idiopathic scoliosis is 0.47–5.2% [2]. Neurophysiologic intraoperative monitoring (NIOM) is routinely performed at our institution for all pediatric patients undergoing posterior spinal fusion for scoliosis treatment. An NIOM monitoring plan including upper and lowe
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