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Multimodal nerve monitoring during periacetabular osteotomy identifies surgical steps associated with risk of injury

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Abstract

Purpose

Sciatic nerve palsy after periacetabular osteotomy (PAO) is a serious complication. The purpose of this study was to determine whether a multimodal sciatic monitoring technique allows for identification of surgical steps that place the sciatic nerve at risk.

Methods

Transcranial electrical motor evoked potentials (TcMEPs), somatosensory evoked potentials (SSEPs), and spontaneous electromyography (EMG) were monitored in a consecutive series of 34 patients (40 hips) who underwent PAO for the treatment of symptomatic hip dysplasia between January 2012 and November 2014. There were 29 females (85%) and five males (15%) with an average age of 19 years (range, 12–36 years) at the time of surgery.

Results

We detected eight temporary sciatic nerve monitoring alerts in six patients (incidence of 15%). The events included decrease in amplitude of the TcMEPs related to the position of the hip during incomplete ischium osteotomy and placement of a retractor in the sciatic notch during the posterior column osteotomy (N = 3), generalized bilateral decrease in TcMEPs during fragment manipulation and fixation in association with acute blood loss (N = 2), and a change in SSEPs during a superior pubic osteotomy and supra-acetabular osteotomy (N = 1). At the end of the procedure, TcMEPs and SSEPs were at baseline and there was no abnormal pattern on EMG in all patients. Post-operatively, at two, six, 12 weeks, and six and 12 months, no motor weakness or sensory deficits were noted.

Conclusion

Multimodal neuromonitoring allowed for identification of intra-operative steps and maneuvers that potentially place the sciatic nerve at higher risk of injury.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Ave, Hunnewell Building, Boston, MA, 02215, USA

    Eduardo N. Novais

  2. Department of Orthopaedic Surgery, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B060, Aurora, CO, 80045, USA

    Travis Heare & Jason Koerner

  3. Musculoskeletal Research Center, Department of Orthopaedic Surgery, Children’s Hospital Colorado, 13123 East 16th Avenue, B060, Aurora, CO, 80045, USA

    Lauryn Kestel & Jason Koerner

  4. Department of Anesthesiology, Children’s Hospital Colorado, 13123 East 16th Avenue, B090, Aurora, CO, 80045, USA

    Patricia Oliver, Willy Boucharel & Kim Strupp

Authors
  1. Eduardo N. Novais
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  2. Travis Heare
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  3. Lauryn Kestel
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  4. Patricia Oliver
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  5. Willy Boucharel
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Corresponding author

Correspondence to Eduardo N. Novais.

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Conflict of interest

No source of funding was used in this study. Eduardo Novais, Travis Heare, Lauryn Kestel, Patricia Oliver, Willy Boucharel, Jason Koerner, and Kim Strupp declare they have no conflict of interest.

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Novais, E.N., Heare, T., Kestel, L. et al. Multimodal nerve monitoring during periacetabular osteotomy identifies surgical steps associated with risk of injury. International Orthopaedics (SICOT) 41, 1543–1551 (2017). https://doi.org/10.1007/s00264-016-3394-x

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  • DOI: https://doi.org/10.1007/s00264-016-3394-x

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