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STUDY DESIGN.: Case report. OBJECTIVE.: To report a case of a bilateral femoral artery ischemia detected by neuromonitoring during posterior scoliosis surgery and to review relevant literature regarding this rare complication. SUMMARY OF BACKGROUND DATA.: Lower extremity ischemia is a potentially devastating risk of posterior spinal surgery. Ischemia can be a result of thrombotic occlusion or vascular compression during patient positioning. Multimodality neuromonitoring, increasingly used to prevent neurologic injury, can also detect hypoperfusion to the extremities. To date, there have been no reports of bilateral lower extremity ischemia detected by multimodality neuromonitoring during posterior spine surgery. METHODS.: A 15-year-old boy with adolescent idiopathic scoliosis underwent posterior spinal fusion with instrumentation. Intraoperative changes in somatosensory-evoked potentials and motor-evoked potentials were noted 1 hour into the case, before instrumentation or the reduction maneuver. After trouble shooting methods did not localize a technical cause for the changes, the patient's lower extremities were noted to be hypoperfused and pulseless. RESULTS.: The patients was repositioned and lower extremity perfused improved. Palpable distal pulses were detected. Neuromonitoring signals returned to baseline and the surgery completed. The patient had no postoperative neurologic or vascular deficits. CONCLUSION.: Lower extremity ischemia secondary to prone positioning is a rare risk of posterior spinal surgery. This is the first case report of this potentially devastating, but preventable complication detected by multimodality neuromonitoring.
From the Departments of *Orthopaedic Surgery, daggerClinical Neurophysiology, and double daggerAnesthesiology, William Beaumont Hospital, Royal Oak, MI.
This article was published in the following journal.
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A groin hernia occurring inferior to the inguinal ligament and medial to the FEMORAL VEIN and FEMORAL ARTERY. The femoral hernia sac has a small neck but may enlarge considerably when it enters the subcutaneous tissue of the thigh. It is caused by defects in the ABDOMINAL WALL.
The main artery of the thigh, a continuation of the external iliac artery.
Disease involving the femoral nerve. The femoral nerve may be injured by ISCHEMIA (e.g., in association with DIABETIC NEUROPATHIES), nerve compression, trauma, COLLAGEN DISEASES, and other disease processes. Clinical features include MUSCLE WEAKNESS or PARALYSIS of hip flexion and knee extension, ATROPHY of the QUADRICEPS MUSCLE, reduced or absent patellar reflex, and impaired sensation over the anterior and medial thigh.
The vein accompanying the femoral artery in the same sheath; it is a continuation of the popliteal vein and becomes the external iliac vein.
The continuation of the femoral artery coursing through the popliteal fossa; it divides into the anterior and posterior tibial arteries.
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