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Rehabilitation Practice and Science

Abstract

Surgical resection of a spinal tumor is the first choice of treatment in clinical practice, however it carries a significant risk of creating new postoperative neurological deficits. It is believed that the concomitant use of intraoperative neurophysiological monitoring (IONM) during tumor resection can not only increase safety of the procedure, but also improve surgical outcomes.

Case description:

A 52-year-old female who was in good health and neurologically intact presented with intermittent claudication, numbness and weakness of bilateral lower extremities, and bowel and urinary incontinence in June 2021. L-spine MRI revealed an intradural extramedullary tumor at T8 level. She received T7-9 laminectomy and tumor removal under IONM throughout the procedure. Preoperatively, except for motor-evoked potentials (MEPs) over the left lower limb, there were no elicitable somatosensory-evoked potentials (SSEPs) from bilateral tibial nerves or direct waves(D-waves), possibly related to a preoperative neurological deficit. D-waves appeared 30 minutes after beginning of tumor resection. MEPs over bilateral lower extremities showed significant improvement at the end of resection as well, although bilateral tibial SSEPs were not recordable.

Improved motor control and muscle power of bilateral lower limbs were noted after the operation, however numbness over the right lower limb and poor proprioception were also noted, which affected her locomotion. At 4 months of follow-up, the numbness and impaired proprioception over the right lower limb had significantly improved, and her bowel and bladder function had also returned to normal.

Conclusion:

This case indicates that the application of IONM during resection of a spinal tumor can not only increase the safety of the surgical procedure, but also accurately predict postoperative functional outcomes.

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