Immediately after closing the osteotomy for correction of a thoracolumbar scoliosis, the intraoperative monitoring technician informs you that there has been a sudden > 50% decrease in amplitude on the motor evoked potentials. What is the first step in management?
67% reverse osteotomy closure
0% reverse osteotomy closure
33% 0% The correct answer is reverse osteotomy closure.
In general, when signals are lost the last maneuver performed in the operation should be reversed if possible. Maneuvers such as checking for anesthetic changes , checking the leads, increasing blood pressure and performing a wake-up test may all be performed subsequently.