Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors

Liu, Wanyou; Qiu, Junyin; Zhu, Zezhang; Shi, Benlong; Li, Yang; Liu, Zhen; Sun, Xingming; Qiu, Yong

doi:10.1097/wnp.0000000000000924

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…Any irritation to the spinal cord during procedures such as apical pediculectomy, circumferential spinal cord decompression, and osteotomy might lead to temporary decreases in IONM waveforms, particularly in MEP monitoring. Another study 11 involving 551 patients undergoing 3CO reported 17.8% IONM alerts during surgery, aligning more closely with our findings due to similar criteria for defining such alerts.…”

Section: Discussionsupporting

confidence: 90%

“…IONM alerts were triggered when (1) an increase in somatosensory-evoked potentials (SSEP) latency exceeding 10%; (2) a decrease in SSEP amplitude exceeding 50%; and (3) a decrease in motor-evoked potentials (MEP) amplitude exceeding 80% 10,11 . It is imperative to initially exclude interference from anesthesia and monitoring workstations.…”

Section: Methodsmentioning

confidence: 99%

“…(3) a decrease in motor-evoked potentials (MEP) amplitude exceeding 80%. 10,11 It is imperative to initially exclude interference from anesthesia and monitoring workstations. Surgeons should promptly suspend any high-risk procedures and maintain a mean arterial pressure above 75 to 80 mm Hg.…”

Section: Ionm Alertsmentioning

confidence: 99%

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Assessing Neurological Complications in Thoracic Three-Column Osteotomy

Lo,

Shi,

Lin

et al. 2024

Spine

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Study Design: Retrospective comparative study. Objective: To investigate the occurrence of neurologic complications in patients undergoing thoracic three-column osteotomy (3CO) utilizing an MRI-based classification that assesses spinal cord shape and the presence of cerebrospinal fluid (CSF) at the curve apex, and evaluate its prognostic capacity for postoperative neurologic deficits. Summary of Background Data: Recent advancements in correction techniques have improved outcomes for severe spinal deformity patients undergoing 3CO. A novel MRI-based spinal cord classification system was introduced, but its validation and association with postoperative complications remain unexplored. Materials and Methods: Between September 2012 and September 2018, a retrospective analysis was conducted on 158 adult patients with spinal deformities undergoing 3CO. Radiographic parameters were measured. T2-weighted axial MRI was employed to describe spinal cord morphology at the apex. Intraoperative neurophysiologic monitoring (INOM) alerts were recorded, and preoperative and postoperative neurologic functions were assessed using the Frankel score. Categorical data were compared using the Chi-Square or Fisher’s exact test. The paired t-test was utilized to assess the mean difference between pre- and postoperative measurements, while the one-way ANOVA and independent t-test were employed for comparative analyses among the different spinal cord types. Results: Patients were categorized into three groups: type 1, type 2, and type 3, consisting of 12, 85, and 61 patients. Patients with type 3 morphology exhibited larger Cobb angles of the main curve (P<.001). This disparity persisted both postoperatively and during follow-up (P<.05). IONM alerts were triggered in 32 patients (20.3%), with a distribution of one case in type 1, six cases in type 2, and 22 cases in type 3 morphologies (P<.001). New neurologic deficits were observed in 15 patients (9.5%), with one, three, and 11 cases in type 1, 2, and 3 morphologies, respectively. Conclusions: Patients with type 3 morphology exhibited greater spinal deformity severity, higher likelihood of preoperative neurologic deficits, and an elevated risk of postoperative neurologic complications. This underscores the utility of the classification as a tool for predicting postoperative neurologic complications in patients undergoing thoracic 3CO. Level of Evidence: Level IV.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

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Assessing Neurological Complications in Thoracic Three-Column Osteotomy

Lo,

Shi,

Lin

et al. 2024

Spine

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Potential impairment of spinal cord around the apical vertebral level in hyperkyphotic patients: findings from diffusion tensor imaging

Xu,

Zhou,

Ling

et al. 2024

Eur Spine J

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The Role of Spinal Cord Compression in Predicting Intraoperative Neurophysiological Monitoring Events in Patients With Kyphotic Deformity: A Magnetic Resonance Imaging-Based Study

Jin,

Li,

et al. 2024

Neurospine

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Objective: To establish a novel classification system for predicting the risk of intraoperative neurophysiological monitoring (IONM) events in surgically-treated patients with kyphotic deformity.Methods: Patients with kyphotic deformity who underwent surgical correction of cervicothoracic, thoracic, or thoracolumbar kyphosis in our center from July 2005 to December 2020 were recruited. We proposed a classification system to describe the morphology of the spinal cord on T2-weighted sagittal magnetic resonance imaging: type A, circular/symmetric cord with visible cerebrospinal fluid (CSF) between the cord and vertebral body; type B, circular/oval/symmetric cord with no visible CSF between the cord and vertebral body; type C, spinal cord that is fattened/deformed by the vertebral body, with no visible CSF between the cord and vertebral body. Furthermore, based on type C, the spinal cord compression ratio (CR) < 50% was defined as the subtype C-, while the spinal cord CR ≥ 50% was defined as the subtype C+. IONM event was documented, and a comparative analysis was made to evaluate the prevalence of IONM events among patients with diverse spinal cord types.Results: A total of 294 patients were reviewed, including 73 in type A; 153 in type B; 53 in subtype C- and 15 in subtype C+. Lower extremity transcranial motor-evoked potentials and/or somatosensory evoked potentials were lost intraoperatively in 41 cases (13.9%), among which 4 patients with type C showed no return of spinal cord monitoring data. The 14 subtype C+ patients (93.3%) had IONM events. Univariate logistic regression analysis showed that patients with a type C spinal cord (subtype C-: odds ratio [OR], 10.390; 95% confidence interval [CI], 2.215–48.735; p = 0.003; subtype C+, OR, 497.000; 95% CI, 42.126– 5,863.611; p < 0.001) are at significantly higher risk of a positive IONM event during deformity correction compared to those with a type A. In further multiple logistic regression analysis, the spinal cord classification (OR, 5.371; 95% CI, 2.966–9.727; p < 0.001) was confirmed as an independent risk factor for IONM events.Conclusion: We presented a new spinal cord classification system based on the relative position of the spinal cord and vertebrae to predict the risk of IONM events in patients with kyphotic deformity. In patients with type C spinal cord, especially those in C+ cases, it is essential to be aware of potential IONM events, and adopt standard operating procedures to facilitate neurological recovery.

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Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors

Cited by 3 publications

References 20 publications

Assessing Neurological Complications in Thoracic Three-Column Osteotomy

Assessing Neurological Complications in Thoracic Three-Column Osteotomy

Potential impairment of spinal cord around the apical vertebral level in hyperkyphotic patients: findings from diffusion tensor imaging

The Role of Spinal Cord Compression in Predicting Intraoperative Neurophysiological Monitoring Events in Patients With Kyphotic Deformity: A Magnetic Resonance Imaging-Based Study

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