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Delayed neuromonitoring alarm after scoliosis correction in Lenke type 4 adolescent idiopathic scoliosis
  1. Go Yoshida,
  2. Tomohiko Hasegawa,
  3. Yu Yamato and
  4. Yukihiro Matsuyama
  1. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
  1. Correspondence to Dr Go Yoshida; goy{at}


A 12-year-old girl underwent surgery for Lenke type 4 adolescent idiopathic scoliosis. After scoliosis correction, the transcranial motor-evoked potential (Tc-MEP) showed no alarm. However, the Tc-MEP amplitude had declined ~10 min after correction, with a normal blood pressure (BP) and body temperature and without any technical monitoring errors. Therefore, we suspected indirect spinal cord ischaemia because of the delayed true-positive Tc-MEP alarm. All the strong corrections made loss of Tc-MEP and all the correction releases made recovers of waveform. Finally, a weak correction was performed, and the Tc-MEP amplitude was recovered. Because transient spinal cord ischaemia due to correction of triple curves may cause a delayed monitoring alarm, the monitoring team should frequently check Tc-MEP after these manoeuvres. This patient had no neurological deficits and was considered to be a rescue case.

  • orthopaedics
  • spinal cord

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  • Contributors The report was written by GY, TH and YY. Supervised by YM. Patient was under the care of TH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.