Case 51 - Perioperativeperipheral nerve injury

Summary

Neurosurgical procedures are often performed with patients in the prone, lateral, and other non-supine positions. This creates the risk of perioperative neurologic deficit due to peripheral nerve injury (PNI). This chapter presents a case study of a 55-year-old female presented for scoliosis correction with posterior instrumentation at T5-L5. The patient was presumed to have a right brachial plexus injury and was started on dexamethasone. Neurology and physical therapy were consulted after admission to the neurosurgical intensive care unit. Vigilance with respect to positioning and appropriate padding of pressure points is critical, especially in patients with diabetes mellitus, hypertension, and a history of tobacco use. Neurophysiologic monitoring may aid in the intraoperative detection of injury and should be taken seriously. Evidence of PNI should prompt an evaluation by neurology, as well as the involvement of physical and occupational therapy.