Spinal cord monitoring during scoliosis surgery

What is the spinal cord?

The spinal cord is joined to the brain and sits inside the spine. It is extremely important as it carries nerve signals between the brain and the body.

If the spinal cord is damaged this can block nerve signals being carried and cause loss of feeling and paralysis. The higher up the spinal cord this occurs the worse the problem could be.

What is spinal cord monitoring and why is it needed?

Spinal cord monitoring is a way of recording and monitoring the nerve signals carried through the spinal cord throughout the surgery. This is done with the aim of protecting 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 will monitor the nerve signals carried through 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 done?

Somatosensory evoked potential monitoring (SEP)

Somatosensory evoked potential monitoring (SEP) is done by stimulating the nerves in your child’s legs and arms to send nerve signals up through the spinal cord. This is then recorded either at the back of the neck or on the head. This monitors the sensory side of the nervous system.

Motor evoked potential monitoring (MEP)

Motor evoked potential monitoring (MEP) is done by stimulating your child’s brain to send nerve signals down the spinal cord. This is then recorded in muscles from the legs and arms. This monitors the motor or movement side of the nervous system.

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

How do you prepare my child for spinal cord monitoring?

As the nerve signals are very small, a combination of needle electrodes and stick-on electrodes are used.

The needle electrodes are inserted just underneath you child’s skin while they are asleep. These will be removed before your child wakes up.

Afterwards there may be small 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.

Is spinal cord monitoring safe for my child?

SEP is safe for all children. It will be used in all scoliosis surgeries unless it is not technically possible.

MEP is safe for the majority of children. Some pre-existing conditions may make it inadvisable to stimulate the brain in the way necessary for MEP monitoring. Your surgeon will discuss this in more detail and may ask questions about your child’s medical history, such as:

• seizures or unexplained blackouts
• previous intracranial bleed or tumour
• implanted devices such as baclofen pump, vagus nerve stimulator or cochlear implant
• head injury (including surgery) or intracranial implant
• if your child is less than 2 years old

Other considerations

If your child has a low hairline at the back of their neck, we may have to shave a little bit so we can put the electrodes in the right place.

How to prepare

For your child’s last bath or shower before their surgery, please use plain shampoo, soap and no skin moisturiser.

This is because some shower gels, hair conditioners and skin moisturisers can leave a film on the skin making the electrodes difficult to attach.