• N R Holland and J P Kostuik.
• Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
• Spine. 1997 Nov 1;22(21):2547-50.

Study DesignThe results of intraoperative monitoring during a case of nerve root injury sustained from scoliosis surgery to the thoracolumbar spine are described.ObjectivesTo improve the efficacy of intraoperative monitoring in preventing nerve root injury during scoliosis surgery.Summary Of Background DataPosterior tibial nerve somatosensory-evoked potentials are the electrophysiologic modality most commonly used for spinal cord monitoring during thoracolumbar spine surgery. Although radiculopathy is a more frequent postoperative complication than myelopathy, monitoring of mixed-nerve, somatosensory-evoked potentials may not detect injuries to individual nerve roots.MethodsThe patient described in this report developed left L5 radiculopathy after scoliosis surgery to the thoracolumbar spine. During surgery, intraoperative electromyographic monitoring identified frequent trains of neurotonic discharges in the left anterior tibial muscle. Bilateral, posterior, tibial nerve, somatosensory-evoked potentials remained normal. The left L5 nerve root was explored 9 days after the original surgery and was found to be compressed by bony structures. Electrophysiologic testing showed that the nerve root had undergone significant Wallerian degeneration, but remained in partial continuity.ResultsNerve root injury was detected by neurotonic discharges identified during intraoperative electromyographic monitoring, but not by somatosensory-evoked potentials, which remained normal. When the injured nerve root was explored, a simple electromyographic technique was used to characterize the extent and type of injury.ConclusionsThe authors of this study recommend electromyographic monitoring of appropriate lumbosacral myotomes in addition to somatosensory-evoked potentials during this type of procedure.

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