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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1811691
Case Report

Value of Intraoperative Neuromonitoring in Spinal Tuberculosis Surgery: Case Report of Neurological Compromise with Normal Imaging

Authors

  • Yogesh Kumar 

    1   Department of Physiology, All India Institute of Medical Sciences, Patna, Bihar, India

  • Avinash Kumar

    2   Department of Orthopaedics, All India Institute of Medical Sciences, Patna, Bihar, India

  • Zakiyyah Tasneem 

    1   Department of Physiology, All India Institute of Medical Sciences, Patna, Bihar, India

  • Nirangjhana Sivasubramanian 

    1   Department of Physiology, All India Institute of Medical Sciences, Patna, Bihar, India
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Abstract

Spinal tuberculosis (TB), also known as Pott's spine, remains a significant cause of spinal deformity and neurological compromise, particularly in endemic regions. Surgical correction of chronic deformities is associated with significant risks, including spinal cord injury. Intraoperative neurophysiological monitoring (IONM) has become an essential tool to minimize neurological complications. We report a case of an adolescent boy with longstanding thoracolumbar kyphosis due to spinal TB, where IONM identified true positive motor pathway compromise during deformity correction, despite intraoperative C-arm imaging confirming correct pedicle screw placement. Surgery was halted, and staged completion was planned. Postoperative neurological deficits confirmed the predictive validity of IONM. This case highlights the indispensable role of IONM in surgical decision-making, particularly in complex TB-related deformities where imaging alone may be insufficient to prevent neurological injury.

Keywords

Pott's spine - spinal tuberculosis - intraoperative neuromonitoring - kyphotic deformity - spinal cord injury

Note

The manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.


Authors' Contributions

Y.K., A.K., and N.S. were directly involved in the patient's care. N.S. and Z.T. contributed to drafting the manuscript, sourcing and editing clinical images, compiling investigation results, preparing original diagrams and algorithms, and critically revising the work for important intellectual content. Y.K. and A.K. gave final approval of the manuscript. Y.K., as the clinician in charge of the patient's care, supervised the preparation of the manuscript, obtained informed consent from the patient/guardian/family members, and takes overall responsibility for the integrity of the content.




Publication History

Article published online:
17 September 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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