Download PDF
CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(02): 125-127
DOI: 10.1055/s-0043-1764297
Case Report

Failure of Sequential Compression Device Detected by Neuromonitoring during Minimally Invasive Posterior Scoliosis Surgery

Kristen D. Raue 
1   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Jay Shils
2   Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, United States
,
Richard G. Fessler 
1   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Intraoperative neuromonitoring is recommended as standard practice for corrective scoliosis surgery. Common methods include somatosensory-evoked potentials (SSEPs) and transcranial motor-evoked potentials (TcMEPs), which have been shown to have a high diagnostic accuracy in detecting new neurological deficits postoperatively. Sequential compression devices (SCDs) are a common method for thromboprophylaxis in spine surgery and are not known to have many device-related complications. To date, there have been no reports of lower extremity ischemia secondary to SCD deflation failure detected by multimodality neuromonitoring during minimally invasive posterior spine surgery. We, therefore, present a case report of an 18-year-old male with adolescent idiopathic scoliosis who underwent minimally invasive posterior spinal fusion with instrumentation. Intraoperative decrease in SSEPs and TcMEPs were noted in the left leg shortly after incision before any instrumentation or reduction occurred. Further examination revealed that the left leg was hypoperfused compared with the right leg and that the left SCD was not properly deflating. Bilateral SCDs were removed, and perfusion and neuromonitoring returned to baseline immediately. Bilateral SCDs and the machine were replaced, and neuromonitoring remained within normal limits for the rest of the surgery. The patient had no postoperative neurologic or vascular deficits. Early detection of lower extremity ischemia by neuromonitoring resulted in the prompt identification and addressing of SCD malfunction, sparing devastating neurological and vascular injury to the patient's leg. This case reinforces the importance of neuromonitoring within spine surgery.

Keywords

neuromonitoring - scoliosis - sequential compression device


Publication History

Article published online:
14 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Strike SA, Hassanzadeh H, Jain A. et al. Intraoperative neuromonitoring in pediatric and adult spine deformity surgery. Clin Spine Surg 2017; 30 (09) E1174-E1181
    CrossrefPubMedGoogle Scholar
  • 2 Thirumala PD, Crammond DJ, Loke YK, Cheng HL, Huang J, Balzer JR. Diagnostic accuracy of motor evoked potentials to detect neurological deficit during idiopathic scoliosis correction: a systematic review. J Neurosurg Spine 2017; 26 (03) 374-383
    CrossrefPubMedGoogle Scholar
  • 3 Thirumala PD, Cheng HL, Loke YK, Kojo Hamilton D, Balzer J, Crammond DJ. Diagnostic accuracy of somatosensory evoked potential monitoring during scoliosis fusion. J Clin Neurosci 2016; 30: 8-14
    CrossrefPubMedGoogle Scholar
  • 4 Thirumala PD, Huang J, Thiagarajan K, Cheng H, Balzer J, Crammond DJ. Diagnostic accuracy of combined multimodality somatosensory evoked potential and transcranial motor evoked potential intraoperative monitoring in patients with idiopathic scoliosis. Spine 2016; 41 (19) E1177-E1184
    CrossrefPubMedGoogle Scholar
  • 5 Adeeb N, Hattab T, Savardekar A. et al. Venous thromboembolism prophylaxis in elective neurosurgery: a survey of board-certified neurosurgeons in the United States and updated literature review. World Neurosurg 2021; 150: e631-e638
    CrossrefPubMedGoogle Scholar
  • 6 Spain DA, Bergamini TM, Hoffmann JF, Carrillo EH, Richardson JD. Comparison of sequential compression devices and foot pumps for prophylaxis of deep venous thrombosis in high-risk trauma patients. Am Surg 1998; 64 (06) 522-525 , discussion 525–526
    PubMedGoogle Scholar
  • 7 Tseng MD, Cappetto L, Majid K, Sternberg D, Settecerri JJ. Bilateral femoral artery ischemia detected by multimodality neuromonitoring during posterior scoliosis surgery: a case report. Spine 2010; 35 (16) E799-E803
    CrossrefPubMedGoogle Scholar
  • 8 Vossler DG, Stonecipher T, Millen MD. Femoral artery ischemia during spinal scoliosis surgery detected by posterior tibial nerve somatosensory-evoked potential monitoring. Spine 2000; 25 (11) 1457-1459
    CrossrefPubMedGoogle Scholar
  • 9 Gilbart MK, Oglivie-Harris DJ, Broadhurst C, Clarfield M. Anterior tibial compartment pressures during intermittent sequential pneumatic compression therapy. Am J Sports Med 1995; 23 (06) 769-772
    CrossrefPubMedGoogle Scholar
  • 10 Fiore M, Ruffilli A, Viroli G, Barile F, Manzetti M, Faldini C. Minimally invasive surgery using posterior-only pedicle screw fixation in treatment of adolescent idiopathic scoliosis: a systematic review and meta-analysis. J Clin Neurosci 2022; 99: 317-326
    CrossrefPubMedGoogle Scholar
  • 11 Vitale MG, Skaggs DL, Pace GI. et al. Best practices in intraoperative neuromonitoring in spine deformity surgery: development of an intraoperative checklist to optimize response. Spine Deform 2014; 2 (05) 333-339
    CrossrefPubMedGoogle Scholar
  • 12 Lenke LG, Fano AN, Iyer RR. et al. Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery. Spine Deform 2022; 10 (04) 745-761
    CrossrefPubMedGoogle Scholar