D-Wave Spinal Cord Monitoring to Obviate the Need for Transcranial Motor Evoked Potentials in a Patient With Bilateral Deep Brain Stimulators Undergoing Spinal Deformity Correction: A Case Report

Intraoperative neuromonitoring (IONM) involves repeated electrical stimulation of the nervous system to assess integrity of neural pathways. Transcranial motor evoked potentials (tcMEPs) require high levels of electrical stimulation and are not recommended for patients with neurologic stimulators in situ, such as a deep brain stimulator (DBS) system, due to the risk of device damage and patient harm. We describe a case of a patient with bilateral DBS undergoing a surgery with IONM, in which direct electrical response wave (D-wave) monitoring via an epidural electrode was used, rather than tcMEPs, to monitor the motor tracts while protecting and preserving the DBS.