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Leah Solano
MVS 465
10 December 2015
CASE REVIEW: 10 NOVEMBER 2015
INTRODUCTION
• Two different changes in IONM signals, two different causes
• True change, by surgical manipulation
• Anesthetic change
• Anesthesia’s goals do not always coincide with our goals
PATIENT, SYMPTOMS & DIAGNOSIS
• Patient: 7 y.o. female
• Halo traction prior to surgery
• No neurological deficits at time of surgery
• Diagnosis: Congenital Scoliosis
PRE-OP X-RAY
PRE-OP X-RAY
• Surgeon: Dr. Farley
• Surgical treatment plan:
• Growing Rod Placement T3-
L4
• Smith-Peterson
Osteotomies with
allograft and autograft
• Intraoperative Monitoring Requested:
• UE and LE bilateral SSEPs
• MEP and spEMG
• Responses recorded from: bilateral APB-ADM, AB, IL, VL, BF, TA, GA, AH.
• *C3 electrode had to be placed nearer to Oz due to surgical site constraints and open wounds from halo
TREATMENT PLAN
BASELINE SSEPS
BASELINE SSEPS
BASELINE MEPS
FIRST CHANGE: LOSS OF MOTORS; MEP PRE-
DEROTATION
FIRST CHANGE: LOSS
OF MOTORS
FIRST CHANGE: LOSS OF MOTORS; SIGNAL RETURN
SECOND CHANGE: ANESTHETIC
• For the majority of the procedure, anesthesia consisted of Isoflurane (0.3 MAC),
Sufentanil, and Midazolam
• Near closing anesthetic regimen was changed to a combination of Isoflurane and Nitrous
Oxide at 1.3 MAC, Sufenta turned off
• Anesthesia’s goals: analgesia, amnesia, sedation, muscle relaxation, as well as a
timely wakeup
• Surgeon’s goals: Acquisition of reliable MEPs to ensure final surgical manipulations
would not cause spinal cord insult.
• Solution: Anesthesia changed the regimen back to Isoflurane at 0.4 MAC and
Sufentanil/Midazolam, and signals regained reliability.
SECOND CHANGE: ANESTHETIC
SECOND CHANGE: ANESTHETIC; SSEP LATENCY RETURN
Iso & N20
(1.3 MAC)
Iso (0.4 MAC) &
Sufenta/Midazolam
SECOND CHANGE: ANESTHETIC
REDUCTION IN MEP AMPLITUDE
SECOND CHANGE: ANESTHETIC; MEP AMPLITUDE
RETURN
CONCLUSION
• By closing, SSEPs and MEPs were stable and reliable, EMG quiet
• Patient woke able to move all extremities
Pre-op
Post-op
