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

Published:November 03, 2017DOI:


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


      A descriptive study was conducted.


      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.


      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.


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


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      Lin Rui, BSN, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital Nanjing University, Nanjing, Jiangsu, China


      Guomei Xu, MSN, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital Nanjing University, Nanjing, Jiangsu, China


      Xiaofan Lv, MSN, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital Nanjing University, Nanjing, Jiangsu, China


      Zhengliang Ma, MD, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital Nanjing University, Nanjing, Jiangsu, China