Spinal cord monitoring during scoliosis surgery

What is the spinal cord?

The spinal cord and the brain form the body’s central nervous system. The spinal cord lies inside the spine and it is extremely important as it allows nerve signals (messages) to reach the brain. If the spinal cord was damaged this would cause loss of feeling and paralysis. The higher up the spinal cord this occurs the worse the problem would be.

What is spinal cord monitoring and why is it needed?

Spinal cord monitoring is a way of recording and monitoring the nerve signals within the spinal cord throughout the surgery in order to protect your child’s spinal cord function. During spinal operations the surgeon will work very close to the spinal cord. To lessen the risks a dedicated team of clinical scientists or technologists will monitor the nerve signals within the spinal cord throughout the surgery. It is not possible to eliminate all risks therefore it is important that you fully consider the risks discussed with your surgeon.

What types of spinal cord monitoring can be performed?

Somatosensory evoked potential monitoring (SEP)

This monitors the sensory side of the nervous system. This is performed by stimulating the nerves within the ankle or lower leg and recording the nerve signals from the spinal cord, either at the back of the neck or on the head.

Motor Evoked Potential Monitoring (MEP)

This monitors the motor or movement side of the nervous system. This is performed by stimulating the brain and recording the signals which occur within the lower leg muscles.

Your surgeon will choose the method which is best for your child

How is my child set-up for spinal cord monitoring?

As the nerve signals are very small, the best and most reliable recordings are gained when a combination of needle electrodes and stick-on electrodes are used. The needle electrodes are inserted just underneath the skin when your child is asleep. The electrodes are all removed before the patient is woken up after the surgery is finished.

Is spinal cord monitoring safe for my child?

SEP is safe for all children. Unless not technically possible it will be used in all scoliosis surgery. MEP is safe for the majority of children. Some pre–existing conditions would make it inadvisable to stimulate the brain in the way necessary for MEP monitoring. Your surgeon will discuss this in more detail and ask questions about your child’s medical history:

• History of seizures or unexplained blackouts
• History of previous intercranial bleed or tumour
• Your child has implanted devices such as a baclofen pump, vagus nerve stimulator or cochlear implant
• History of head injury (including surgery) or intercranial implant
• Age at time of surgery is less than 2 years

Other considerations

Afterwards there may be small superficial grazes in the areas where the electrodes have been placed. These should heal quickly within a few days. They will not cause permanent damage or leave scars.

How to prepare

It is important that the electrodes stick well and are placed in the best position. This may mean that if your child has a low hairline, a small amount may need to be shaved at the back of the neck. Also some shower gels and hair conditioners can leave a film on the skin making the electrodes difficult to attach, please use plain shampoo and soap for the last bath or shower and hair wash before surgery.