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Abstract : Scoliosis can arise from a variety of causes and is defined as a lateral curvature of the spine greater than 10° on an anterior-posterior standing radiograph. This study examines the significance of Transcranial Motor evoked potential (Tc-MEP) in avoiding immediate and persistent neurologic impairments after spinal surgery and compares intraoperative MEP alterations to neurological outcomes. Private Erbil hospitals did this research from March 2021 through May 2022. All participants were told about the electrophysiological assessment and gave informed permission. Al-Nahrain University Faculty of Medicine Institute Review Board authorised the research. A senior neurosurgeon or orthopaedic surgeon diagnosed scoliosis in 51 individuals (23 males, 28 females) aged 12–33 years and 161.45±4.17 cm. The Medical Consultation Office of Erbil Teaching Hospital's neurosurgery and orthopaedic surgery sections and private clinics recommended patients for scoliosis treatment. This study included 51 scoliosis patients. Transcranial Motor-Evoked Potentials (Tc-MEPs) were measured in lower limb muscles, showing a statistically significant decrement in amplitude and increment in latency during surgery compared to baseline. Alarm readings showed a highly significant decrement in amplitude and increment in latency compared to both baseline and intraoperative readings. One specific muscle, Lt Tibialis Anterior, showed a significant decrease in amplitude during surgery compared to baseline and intraoperative readings. Intraoperative MEP neuromonitoring is crucial in preventing neurological injuries during scoliosis surgeries. Tc-MEP provides real-time spinal cord function assessment, enabling more aggressive surgical corrections, while interdisciplinary communication optimizes monitoring effectiveness.

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