During which phase of scoliosis surgery is the spinal cord most at risk for injury?

The phase during spinal surgery when the spinal cord is most at risk for injury is during spinal distraction and sublaminar wiring. This stage involves significant manipulation of the spinal structures, including tension applied to the spinal column.

Sublaminar wiring requires instruments to be placed beneath the lamina, which can inadvertently lead to direct trauma to the spinal cord if proper care is not taken. Additionally, spinal distraction often involves pulling the vertebrae apart to achieve an ideal alignment or correction of the curvature. This force can stretch the spinal cord. If the distraction is too aggressive or not carefully controlled, it can lead to ischemia or physical damage to the spinal cord, making this phase particularly hazardous for spinal cord integrity.

Understanding this risk is crucial for monitoring and implementing protective strategies during this stage of surgery, which includes continuous neurophysiologic monitoring to detect changes in spinal cord function in real time.