Hemodynamic Consideration in Intraoperative Neurophysiological Monitoring in Neuromuscular Scoliosis Surgery

Objective@#To prove the hypothesis that the parameters of intraoperative neurophysiological monitoring (IONM) during will be more deteriorated in neuromuscular scoliosis (NMS) than in adolescent idiopathic scoliosis (AIS). @*Methods@#This retrospective study reviewed the data of 69 patients (NMS=32, AIS=37) who underwent scoliosis surgery under IONM. The amplitude of motor evoked potentials (MEPs), and the amplitude and the latency of somatosensory evoked potentials (SEPs) were examined. Demographic, preoperative, perioperative and postoperative data were analyzed to determine whether they affected the IONM parameters for each group. @*Results@#Of the items analyzed, the bleeding amount was the only significant risk factor for SEP latency deterioration in the NMS group only. The amplitude of SEP and MEP did not correlate with the hemodynamic parameters. The NMS/AIS ratios of the bleeding-related parameters were higher in the order of bleeding amount/weight (2.62, p<0.01), bleeding amount/body mass index (2.13, p<0.01), and bleeding amount (1.56, p<0.01). This study suggests that SEP latency is more vulnerable than SEP or MEP amplitude in ischemic conditions during scoliosis surgery. @*Conclusion@#In NMS patients, it should be considered that the bleeding amount can have a critical effect on intraoperative electrophysiological deterioration.

A Case of Dysphagia due to Cricopharyngeal Dysfunction and Diffuse Idiopathic Skeletal Hyperostosis / 대한연하장애학회지

Cricopharyngeal dysfunction is a disorder in which excessive tension in the upper esophageal sphincter occurs leads to dysphagia. Diffuse idiopathic skeletal hyperostosis is a disease in which excessive bone formation is widely observed in various parts of the body including the cervical spine. This case report shows a dysphagia patient who had cricopharyngeal dysfunction combined with diffuse idiopathic skeletal hyperostosis. A male patient suffering from dysphagia for 4 months visited the hospital. He was examined by using a videofluoroscopic swallow study, which confirmed simultaneous cricopharyngeal dysfunction and diffuse idiopathic skeletal hyperostosis. Considering the advanced age of the patient, a botulinum toxin injection was first administered to treat his cricopharyngeal dysfunction. The patient showed partial improvement with this treatment. However, dysphagia persisted due to incomplete occlusion of the epiglottis by the anterior osteophyte. The patient was in good general condition; therefore a partial cervical corpectomy was performed for cervical diffuse idiopathic skeletal hyperostosis. The patient showed complete recovery from dysphagia post-surgery. In conclusion, two separate treatments were individually given; a botulinum toxin injection for cricopharyngeal dysfunction and surgery for diffuse idiopathic skeletal hyperostosis, and each treatment was confirmed as effective.