Improving safety in spinal deformity surgery: advances in navigation and neurologic monitoring

Abstract

Introduction The treatment of spinal deformities has rapidly changed during the past decade. The advent of new surgical techniques, particularly thoracic pedicle screws and spinal osteotomies, allow more aggressive deformity correction, and require an increased focus on safety. Materials and methods Review of the navigation systems and neuromonitoring techniques currently available. Conclusion Navigation systems today are where intraoperative neuromonitoring was 20 years ago: new, under investigation, not widely accepted, with concerns for cost, safety and efficiency. Navigation enhances the accuracy of pedicle screws placement in deformed spines, reducing the rate of misplaced screws and potential complications. With further use and investigation, navigation, like neuromonitoring, will soon become standard at major spine centers throughout the world.

Monopolar-probe monitoring during spinal surgery with expandable prosthetic ribs

“…Somatosensory evoked potentials (SEPs), motor evoked potentials elicited by transcranial electrical stimulation (tcMEPs), and neurogenic mixed evoked potentials (NMEPs) are the most widely used parameters for assessing the somatosensory and motor pathways of the spinal cord. Intraoperative monitoring (IOM) of the brachial plexus usually relies on SEPs; tcMEPs; or continuous, spontaneous or stimulated electromyography [2][3][4]. Simultaneous IOM of the spinal cord and brachial plexus requires a combination of techniques whose time-consuming and complex implementation is ill-suited to the conditions of surgery and anaesthesia in young children, particularly during revision surgery to provide further lengthening.…”

Validity and utility of monopolar spinal cord stimulation in pediatric scoliosis surgery

“…This indication arises in VEPTR implantation or lengthening, in which there is a risk of injury to both the spine and the plexus [17,18] as highlighted by the case of Patient 19. SSEPs, tcMEPs and triggered or free-running electromyography can be used either separately or in combination for brachial plexus assessment during surgery [19,20]. However, combining these techniques is complicated and time consuming at installation.…”

“…Our procedure also simplifies the method that is currently used to make simultaneous recordings in both upper and lower limbs. Indeed, intraoperative monitoring of the brachial plexus usually relies on SEPs; tcMEPs; or continuous, spontaneous or stimulated electromyography [8,19,20]. All these methods require complex and timeconsuming recording and stimulating procedures that have to be combined to other procedures intended to monitor the spinal cord.…”

Outrigger rod technique for supplemental support of posterior spinal arthrodesis

“…Advances in spinal instrumentation have allowed spine surgeons to successfully address spinal pathology and deformities of increasing complexity [1][2][3][4][5][6]. However, there are high complication rates associated with major spinal reconstruction, including neurologic injury, infection, pseudarthrosis, junctional kyphosis, and instrumentation failure [1,[7][8][9][10][11][12][13][14].…”