A Comprehensive Protocol to Prevent Brachial Plexus Injury During Ankylosing Spondylitis Surgery.

PURPOSE: This article describes a comprehensive protocol to protect the brachial plexus when performing pedicle subtraction osteotomy for ankylosing spondylitis patients with thoracolumbar kyphosis.

DESIGN

A descriptive study was conducted.

METHODS

Records of 101 cases from October 2013 to December 2016 were retrospectively audited. The protocol included five items: (1) preoperative assessment of motion range and nerve function of limbs and trunks; (2) preoperative positioning according to the assessment results; (3) intra-operative somatosensory evoked potential and blood pressure monitoring; (4) intra-operative repositioning according to the monitoring alarm signals; and (5) postoperative neurological function check.

FINDINGS: Five patients showed impending brachial plexus injury indicators, including two who had a decrease in blood pressure and three who had a decrease in the amplitude of somatosensory evoked potential. After adjustment of position and soft pads, one patient had brachial plexus injury (0.99%) and the recovery time was 2 weeks.

CONCLUSIONS

With this comprehensive strategy, the brachial plexus could be effectively protected during the surgery.