# Three-Level Concavity Apical Pediculectomy During Intraoperative Neuromonitoring Loss: Following the Checklist Resulted in an Ambulatory Patient

## TL;DR

This paper discusses a surgical case where intraoperative neuromonitoring was lost but successfully recovered using checklist-guided procedures in a scoliosis patient.

## Contribution

The paper presents a case study demonstrating the successful application of operative guidelines to recover neuromonitoring signals during scoliosis surgery.

## Key findings

- Loss of TcMEPs and SSEPs during surgery was managed using consensus guidelines.
- Post-operative recovery of neuromonitoring signals was achieved.
- The patient remained ambulatory following the procedure.

## Abstract

Adolescent idiopathic scoliosis is the most common form of scoliosis, with severe cases leading to a decline in patients with worsening angulation of deformity. Technical nuances of spinal flexibility and cord type based on the extent of the deformity may impact operating safety and outcome, with risks including neurological loss during and after surgical intervention. Here we present a case of posterior osteotomy and correction of a patient with adolescent idiopathic scoliosis with a T2 - L3 fusion in which transcranial motor evoked potentials (TcMEPs) and somatosensory evoked potentials (SSEPs) were lost intraoperatively, thus requiring application of operative consensus guidelines for the loss of neuromonitoring data. Particularly, the discussion focuses on the decision-making process that resulted in the complete recovery of TcMEPs and SSEPs post-operatively.