PMC9773129_01
Radiography, appearance, and intraoperative neurophysiological monitoring of case 1. Preoperative radiography of the entire spine (A), preoperative appearance in the posterior and lateral views (B), post-operative radiography of the entire spine (C), post-operative appearance in the posterior and lateral views (D). SEPs (E) and MEPs (F) after correction; MEPs of the left (G) and right (H) lower limb after laminectomy; SEPs (I) and MEPs (J) after spinal cord transposition. MEPs: Motor-evoked potentials; SEP: Somatosensory-evoked potentials.
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F2
Preoperative radiography revealed a Cobb angle of 105  and a flexibility index of 23% in the thoracic spine (Figure 2A). The preoperative appearance showed a rib hump, a thoracic trunk shift, and shoulder imbalance (Figure 2B). No abnormal IOM signal was detected throughout the surgery (Figures 2E,F). Subsequently, the MEPs of the left and right lower limbs were recovered partially and slightly, respectively (Figures 2G,H). When transvertebral transposition of the spinal cord was completed, and there was no compression or high tension of the spinal cord in the apical region, the bilateral SEPs and MEPs were progressively recovered (Figures 2I,J), and the correction surgery continued. Post-operative radiography of the entire spine and appearance revealed satisfactory correction (Figures 2C,D).
PMC9773129_02
Radiography, appearance, and intraoperative neurophysiological monitoring of case 2. Preoperative radiography of the entire spine (A), preoperative appearance in the posterior and lateral views (B), post-operative radiography of the entire spine (C), post-operative appearance in the posterior and lateral views (D). SEPs (E) and MEPs (F) after correction; SEPs (G) and MEPs (H) after spinal cord transposition immediately; SEPs (I) and MEPs (J) 15 min later after spinal cord transposition; MEPs (K) at the end of surgery. MEPs: Motor-evoked potentials; SEPs: Somatosensory-evoked potentials.
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F3
Preoperative radiographic images of the entire spine exhibited a Cobb angle of 84  in the thoracic region with kyphosis of 55  (Figure 3A). The preoperative appearance showed the shoulder imbalance and trunk shift (Figure 3B). After the correction of the main thoracic curve, the amplitude of SEPs decreased significantly, and then the MEPs were lost (Figures 3E,F). Subsequently, the bilateral SEPs still showed no change, but the right MEPs were recovered about 15% (Figures 3G,H). About 15 min later (30 min after the IOM alert), the right MEPs were normalized, and the bilateral SEPs and left MEPs were partially recovered (Figures 3I,J). At the end of the surgery, the bilateral SEPs showed total recovery, and the left MEPs were almost recovered (Figure 3K). Post-operative radiography of the entire spine and appearance revealed satisfactory correction (Figures 3C,D).