ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Diagnostic and therapeutic role of IONM in recurrent delayed neural compromise during prone positioning for Occipito-Cervical fusion in ankylosing spondylitis.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntraoperative neurophysiological monitoring (IONM) facilitates real-time assessment of neural integrity during high-risk spinal procedures, particularly those involving the craniovertebral junction and cervical spine. Delayed neurophysiological signal changes associated with patient positioning can arise from various etiologies, including mechanical traction, ischemia, and compressive neuropraxia. These risks are further exacerbated in individuals with ankylosing spondylitis (AS) due to inherent spinal rigidity. CASE PRESENTATION: A 46-year-old male, a known case of AS, with post-traumatic C1-C2 instability and fixed thoracic kyphosis underwent occipito-cervical fusion with continuous multimodal IONM. Baseline and immediate post-positioning signals were normal. However, approximately 30-40 min after prone positioning, a progressive decline in right lowerlimb somatosensory evoked potentials (SSEPs) was observed, followed by attenuation and eventual loss of motor evoked potentials (MEPs). Signals recovered completely upon returning the patient to the supine position, confirming a position-related yet reversible neural conduction compromise. A similar episode recurred upon re-positioning, resolving again after targeted cervical realignment. The procedure concluded without further incident, and the patient emerged neurologically intact.
conclusionThis case highlights the phenomenon of delayed, position-related neurophysiological deterioration during prone spinal surgery. While AS likely contributed to reduced tolerance of the spine to positional stress, other mechanisms such as regional ischemia must also be considered. A near instantaneous reversibility was evidenced despite delayed, protracted and near complete loss of IONM signals. Continuous IONM enabled early recognition and timely intervention, thereby preventing permanent neural injury, emphasizing the importance of vigilant monitoring even during the presumed "non-critical" stages of surgery.
Indexed as
Identifiers
41175210What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.