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Intraoperative neurophysiological monitoring of T9-T10 fracture in a patient with morbid obesity and ankylosing spondylitis: A case report with literature review.

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العنوان: Intraoperative neurophysiological monitoring of T9-T10 fracture in a patient with morbid obesity and ankylosing spondylitis: A case report with literature review.
المؤلفون: Streltzov NA; Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA., Evans LT; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.; Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA., Dustin Boone M; Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA., Root BK; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.; Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA., Calnan DR; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.; Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA., Kobylarz EJ; Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.; Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA., Song Y; Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
المصدر: Clinical neurophysiology practice [Clin Neurophysiol Pract] 2021 Mar 26; Vol. 6, pp. 115-122. Date of Electronic Publication: 2021 Mar 26 (Print Publication: 2021).
نوع المنشور: Case Reports
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 101684308 Publication Model: eCollection Cited Medium: Internet ISSN: 2467-981X (Electronic) Linking ISSN: 2467981X NLM ISO Abbreviation: Clin Neurophysiol Pract Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Amsterdam : Elsevier, [2016]-
مستخلص: Introduction: As the prevalence of obesity continues to rise, there is a growing need to identify practices that protect overweight patients from injury during spine surgery. Intraoperative neurophysiological monitoring (IONM) has been recommended for complex spine surgery, but its use in obese and morbidly obese patients is understudied.
Case Report: This case report describes a patient with morbid obesity and ankylosing spondylitis who was treated for a T9-T10 3-column fracture with a planned, minimally invasive approach. Forty minutes after positioning the patient to prone, the IONM team identified a positive change in the patient's motor responses in the bilateral lower extremities and alerted the surgical team in a timely manner. It turned out that the pressure exerted by gravity on the patient's large pannus resulted in further dislocation of the fracture and narrowing of the spinal canal. The surgical team acknowledged the serious risk of spinal cord compression and, hence, immediately changed the surgical plan to an urgent, open approach for decompression and reduction of the fracture. The patient's lower extremities' motor responses improved after decompression. The patient was ambulatory on post-operative day 2 and pain-free at six-weeks with no other neurologic symptoms.
Significance: The use of IONM in this planned minimally invasive spine surgery for a patient with morbid obesity prevented potentially serious iatrogenic injury. The authors include a literature review that situates this case study in the existing literature and highlights a gap in current knowledge. There are few studies that have examined the use of IONM during spine surgery for morbidly obese patients. More research is needed to elucidate best practices for the use of IONM in spine surgery for morbidly obese patients.
Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(© 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.)
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فهرسة مساهمة: Keywords: Intraoperative neurophysiological monitoring (IONM); Morbid obesity; Thoracic spine fracture
تواريخ الأحداث: Date Created: 20210505 Latest Revision: 20220422
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC8080406
DOI: 10.1016/j.cnp.2021.02.004
PMID: 33948523
قاعدة البيانات: MEDLINE
الوصف
تدمد:2467-981X
DOI:10.1016/j.cnp.2021.02.004