Major Intraoperative Neurologic Monitoring Deficits in Consecutive Pediatric and Adult Spinal Deformity Patients at One Institution

Kamerlink, Jonathan; Errico, Thomas J.; Xavier, Shaun; Patel, Ashish; Patel, Amar D.; Cohen, Alexa; Reiger, Mark; Dryer, Joseph; Feldman, David S.; Lonner, Baron; Beric, Aleksandar; Schwab, Frank

doi:10.1097/brs.0b013e3181c7c8f6

Cited by 71 publications

(40 citation statements)

References 17 publications

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“…In their series of 264 patients, 154 were pediatric cases, and the authors reported incidences of neuromonitoring changes and neurological deficit of 4.6% and 1.1%, respectively. 4 Kundnani et al evaluated 354 consecutive adolescent idiopathic scoliosis patients who underwent spinal deformity surgery with IONM. They had 13 true neurophysiological alerts (3.7% of 354 cases), with 2 (0.6%) of those 13 demonstrating postoperative neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

“…12 Somatosensory evoked potentials (SSEPs) were the first modality to be widely adopted, and have been routinely employed for over 20 years. 4 SSEPs inform the surgeon about the integrity of afferent information in the dorsal columns of the spinal cord. Some limitations of SSEPs include the delay associated with the signal averaging requirements related to data collection and the fact that the anterior spinal artery does not directly supply the dorsal columns.…”

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confidence: 99%

“…10 Taken together, SSEP and tcMEP monitoring provide exceptionally high sensitivity and specificity for communicating intraoperative changes in the spinal cord. 4,5,9,11,15 Despite the increased use of IONM throughout the field of spinal surgery, there is a paucity of literature related to its use in pediatrics as compared with the spinal surgery in adults. 4,5,15 We present the experience of a single institution with IONM and pediatric spinal deformity surgery and one of the largest reported series of IONM changes to date.…”

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confidence: 99%

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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%

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confidence: 99%

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confidence: 99%

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

Ferguson

Hwang

Tataryn

et al. 2014

PED

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“…These rates are within the range of 0.5 to 3% risk of neurological injury reported in the literature for deformity surgeries. [1][2][3][4][5][6][7] Although the findings from this study may seem to suggest that ION may not influence the rate of neurologic injury, this result must be interpreted with caution as inherently riskier surgeries may utilize neuromonitoring more, leading to an actual reduction in injuries more dramatic than observed in this study. Fu et al reported higher rates of neurologic deficits with ION in pediatric spine cases, which were attributed to the disproportionate use of monitoring in higher risk cases.…”

Section: Discussionmentioning

confidence: 90%

“…In spinal deformity surgery, the risk of neurological injury is estimated to be from 0.5 to 3%. [1][2][3][4][5][6][7] These injuries are thought to occur from implant-related damages, correction maneuvers, or ischemia. 8 To decrease the risk of these adverse events, intraoperative neuromonitoring (ION), such as motor-evoked potential (MEP), somatosensory evoked potential (SSEP), and electromyography (EMG), is used to detect impending injury of neural elements.…”

Section: Introductionmentioning

confidence: 99%