Efficacy of Intraoperative Monitoring for Pediatric Patients With Spinal Cord Pathology Undergoing Spinal Deformity Surgery

Tj, Wilson-Holden; Am, Padberg; Lg, Lenke; Bj, Larson; Kh, Bridwell; Gs, Bassett

doi:10.1097/00007632-199908150-00010

Cited by 82 publications

(38 citation statements)

References 23 publications

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“…1,4,6,8,[11][12][13]16 Thuet et al combined electromyography and monitoring of SSEPs, tcMEPs, neurogenic mixed evoked potentials (NMEPs), and dermatomal SSEPs in 3436 pediatric patients undergoing placement of spinal instrumentation and observed neurophysiological changes in 74 patients (2.2%). SSEPs were the only indicator in 35% of cases; NMEPs alone were abnormal in 33%; both were abnormal in 27%; SSEPs and tcMEPs were the indicators in 1.5%; and SSEPs with dermatomal SSEPs represented the only change in 1.5%.…”

Section: Discussionmentioning

confidence: 99%

Neuromonitoring changes in pediatric spinal deformity surgery: a single-institution experience

Ferguson

Hwang

Tataryn

et al. 2014

PED

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Object Intraoperative monitoring of the spinal cord has become the standard of care during surgery for pediatric spinal deformity correction. The use of both somatosensory and motor evoked potentials has dramatically increased the sensitivity and specificity of detecting intraoperative neurophysiological changes to the spinal cord, which assists in the intraoperative decision-making process. The authors report on a large, single-center experience with neuromonitoring changes and outline the surgical management of patients who experience significant neuromonitoring changes during spinal deformity correction surgery. Methods The authors conducted a retrospective review of all cases involving pediatric patients who underwent spinal deformity correction surgery at Shriners Hospital for Children, Philadelphia, between January 2007 and March 2010. Five hundred nineteen consecutive cases were reviewed in which neuromonitoring was used, with 47 cases being identified as having significant changes in somatosensory evoked potentials, motor evoked potentials, or both. These cases were reviewed for patient demographic data and surgical characteristics. Results The incidence of significant neuromonitoring changes was 9.1% (47 of 519 cases), including 6 cases of abnormal Stagnara wake-up tests, of which 4 had corroborated postoperative neurological deficits (8.5% of 47 cases, 0.8% of 519). In response to neuromonitoring changes, wake-up tests were performed in 37 (79%) of 47 cases, hardware was adjusted in 15 (32%), anesthesiology interventions were reported in 5 (11%), hardware was removed in 5 (11%), the patient was successfully repositioned in 3 (6%), and the procedure was aborted in 13 (28%). In 1 of the 4 patients with new postoperative deficits, the deficit had fully resolved by the last follow-up; the other 3 patients had persistent neurological impairment as of the most recent follow-up examination. The authors observed a sensitivity of 100% for intraoperative neuromonitoring. Conclusions Due to the profound risks associated with spinal deformity surgery, intraoperative neurophysiological monitoring is an integral tool to warn of impending spinal cord injury. Intraoperative neuromonitoring appears to provide a safe and useful warning mechanism to minimize spinal cord injury that may arise during scoliosis correction surgery in pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Neuromonitoring changes in pediatric spinal deformity surgery: a single-institution experience

Ferguson

Hwang

Tataryn

et al. 2014

PED

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“…Ao longo da operação e durante os testes de despertar, os parâmetros hemodinâmicos foram semelhantes nos grupos P e M. Não houve diferença significativa na pressão arterial média e na frequência cardíaca em cada tempo de mensuração entre os grupos (figs. [1][2][3][4].…”

Section: Resultsunclassified

“…1 Essas complicações geralmente resultam de fatores complexos, como os efeitos diretos da compressão sobre a medula espinhal, da distração e da isquemia espinal ou hipotensão arterial. [2][3][4] A monitoração da função da medula espinal no intraoperatório é necessária para evitar essa série de complicações. O teste de despertar é um dos métodos usados para a detecção precoce e, possivelmente, a prevenção dessas lesões medulares 5 e foi feito pela primeira vez com sucesso por Vauzella e Stagmara em 1973.…”

Section: Introductionunclassified

Comparação de propofol e midazolam em pacientes submetidos à cirurgia de coluna vertebral com teste de despertar no intraoperatório: estudo clínico randomizado

Canbay¹,

Altıparmak²,

Çelebi³

et al. 2015

Brazilian Journal of Anesthesiology

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“…The risk of neurologic complications following corrective scoliosis surgery has been estimated at between 1.5% and 9% depending on the etiology of the scoliosis (2). The efficacy of intraoperative neuro-monitoring to help overcome complications in pediatric populations undergoing spinal surgery has been established (3).…”

Section: Introductionmentioning

confidence: 99%

Surgeon-driven neurophysiologic monitoring in a spinal surgery population

et al. 2016

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Background: This is a prospective observational study examining the use of a surgeon-driven intraoperative neurophysiologic monitoring system. Intraoperative neurophysiologic monitoring is becoming the standard of care for spinal surgeries with potential post-operative neurologic deficits. This standard applies to both adult and pediatric spinal surgery, but a shortage of appropriately trained and certified technologists and physiologists can compromise monitoring capabilities in some centers. A surgeon-driven, intra-operative monitoring system in the absence of a technologist or physiologist was examined for safety and efficacy.Methods: One hundred thirty-five patients undergoing a variety of spinal procedures were monitored intraoperatively using a surgeon-driven neuro-monitoring system over a period of 80 months. Intraoperative monitoring included serial motor evoked potentials via an automated system that provided visual and audible feedback directly to the operative surgeon. Changes in monitoring and any corresponding surgical responses were evaluated and compared with postoperative neurological status.Results: Of the 135 patients studied, intraoperative adjustments based on neuro-monitoring took place in four patients (3.0%): following reduction in spondylolisthesis, during instrumentation and fusion for a large kyphoscoliosis deformity, due to low hemoglobin, and because of traction. In all cases, surgical and/ or anaesthetic modification restored MEPs toward baseline values. The accuracy of the neuro-monitoring results was sensitive to narcotics, benzodiazepines and changes in haemoglobin concentrations. No new postoperative deficits were observed in any patients in the cohort. Conclusions:The authors concluded that surgeon-driven neuro-monitoring was a safe and effective means of intraoperative neuro-monitoring during spinal surgery. It reliably detected intraoperative insults, which could potentially have resulted in postoperative neurologic compromise, and was not associated with any false-negative results in this cohort. Utility of surgeon-driven monitoring, using validated algorithms, may provide an option for this added safety measure even in cases where monitoring personnel are unavailable.

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Efficacy of Intraoperative Monitoring for Pediatric Patients With Spinal Cord Pathology Undergoing Spinal Deformity Surgery

Abstract: Intraoperative monitoring should be used in patients with spinal cord pathology who undergo surgery for spinal deformity. Monitoring should not miss a neurologic deficit but demonstrates greater variability, resulting in more frequent use of an intraoperative wake-up test.

Cited by 82 publications

References 23 publications

Neuromonitoring changes in pediatric spinal deformity surgery: a single-institution experience

Neuromonitoring changes in pediatric spinal deformity surgery: a single-institution experience

Comparação de propofol e midazolam em pacientes submetidos à cirurgia de coluna vertebral com teste de despertar no intraoperatório: estudo clínico randomizado

Surgeon-driven neurophysiologic monitoring in a spinal surgery population

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