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Rehabilitation Practice and Science

Translated Title

誘發電位及肌電圖在嚴重脊椎側彎融合手術的應用：病例報告

Abstract

Surgical intervention is frequently suggested for scoliosis patients who have a Cobb's angle of more than 50 degrees and who are not responding to conservative treatment such as bracing. In addition, surgical intervention prevents further deterioration of spinal curvature, preserves cardiopulmonary function, provides cosmetic benefits, and improves quality of life for patients. Although the goal of surgical intervention is to improve the balance and function of the spine, iatrogenic spinal cord and nerve injury remains a major concern. Certain instruments are useful in preventing this type of iatrogenic injury. A combination of somatosensory-evoked potentials, motor-evoked potentials, and pedicle screw stimulation allow immediate detection of neurological changes during surgery and reduce the risk of permanent neurological deficits.The 26-year-old woman who is the focus of this case study was diagnosed with severe scoliosis with a primary Cobb's angle of 111 degrees. She underwent the first stage of surgical intervention, which included Ponte osteotomy and pedicle screw insertion. Neurophysiologic intraoperative monitoring of somatosensory-evoked potentials, motor-evoked potentials, and pedicle screw stimulation was conducted during surgery. However, an action potential that may have been caused by medial breach was detected during pedicle screw stimulation of 4.5 mA after the screw was inserted into the left T7 pedicle. This potential disappeared after redirection of the pedicle screw. No significant changes of somatosensory-evoked potentials and motor-evoked potentials had occurred by the end of the surgery. The patient returned to consciousness without any neurological damage. Posterior instrumentation with fusion was performed after the patient received halo-femoral traction for two weeks. The post-operative Cobb's angle was 62 degrees. However, although no significant change of somatosensory-evoked potentials and motor-evoked potentials was detected during surgery, numbness over the right inguinal area and the upper third of the anterior thigh developed 3 days after the second intervention. Neurological examination showed hypoesthesia over the right T12 and L1 dermatome, and a nerve conduction study and electromyography suggested right T12/L1 radiculopathy. The patient's numbness improved after a vitamin B12 supplement and gabapentin was prescribed. At the 3rd month of follow-up, the patient was content with her appearance and reported improved speed of gait and quality of life. (Tw J Phys Med Rehabil 2012; 40(2): 117 - 123)

Language

Traditional Chinese

First Page

117

Last Page

123

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