Neuromonitoring Changes Are Common and Reversible With Temporary Internal Distraction for Severe Scoliosis

Skaggs, David L.; Lee, Christopher; Myung, Karen S.

doi:10.1016/j.jspd.2013.09.009

Cited by 18 publications

(34 citation statements)

References 38 publications

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“…However, if the procedure was irreversible (i.e., in the case of a vertebral column resection), the spine was stabilized and the procedure was aborted. 9 Immediate postoperative evaluations were performed by the IONM professionals to ensure accurate measures.…”

Section: Interventionmentioning

confidence: 99%

Intraoperative neuromonitoring alerts in a pediatric deformity center

Zuccaro¹,

Zuccaro²,

Samdani

et al. 2017

Neurosurgical Focus

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OBJECTIVEIntraoperative neuromonitoring (IONM) involves the use of somatosensory evoked potentials (SSEPs) and transcranial electric motor evoked potentials (TceMEPs). In this retrospective study the authors examined the sensitivity and specificity of both SSEPs and TceMEPs during pediatric spinal deformity surgeries.METHODSThe authors performed a retrospective quantitative analysis of data obtained in 806 patients (197 males and 609 females) treated from December 2011 until October 2015. All patients were diagnosed with scoliosis that was classified as one of the following: adolescent idiopathic scoliosis (AIS) (38%), congenital scoliosis (22%), or syndromic scoliosis (40%). Also, 53 patients underwent vertebral column resection (VCR). All surgeries were monitored by high-level neuromonitoring specialists and were performed with total intravenous anesthesia. Alerts were described as a decrease in amplitude by 50% or greater (bilateral or unilateral) in SSEPs, TceMEPs, or both.RESULTSTrue-positive alerts for TceMEPs were observed in 60 of the 806 patients (7.4%). True-positive alerts for SSEPs were observed in 7 of the 806 patients (0.9%). In contrast, there were no false-positive or false-negative outcomes. Only 1 case (0.1%) was reported with a permanent postoperative deficit. No reported false negatives or false positives were observed, and thus sensitivity was 100% and specificity was 93%–100% for TceMEPs. The rate of sensitivity was 13.2% and the rate of specificity was 100% for SSEPs. The breakdown of total alert was as follows: 6.6% in AIS cases, 24.5% in congenital scoliosis cases, and 10.2% in syndromic scoliosis cases. Neurological injury rates were significantly lower than in previous studies, as there were 0% for AIS cases (p = 0.12), 0.6% for congenital scoliosis cases (p = 0.17), and 0% for syndromic scoliosis cases (p = 0.07). One injury in a patient with congenital scoliosis occurred during a VCR procedure, which brought the injury rate to 1.9% (p < 0.005). IONM alerts occurred during 34% of rod/correction cases, 25% of thoracic screw placements, 20% of the osteotomies, 17% of the resections, 3% of the cage insertions, and 2% of the sublaminar wiring procedures.CONCLUSIONSThe authors hypothesize that the results of this study will support the necessity, as a standard of care, of multimodality neuromonitoring during high-risk pediatric spinal deformity surgery because of the decrease in postoperative deficits. Their data suggest that the TceMEPs are more sensitive than SSEPs, but when used in combination, they offer the patient a level of safety that would otherwise not exist. Last, these findings support the notion that better outcomes are achieved with high-level IONM professionals.

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Section: Interventionmentioning

confidence: 99%

Intraoperative neuromonitoring alerts in a pediatric deformity center

Zuccaro¹,

Zuccaro²,

Samdani

et al. 2017

Neurosurgical Focus

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“…Full-length upright anteroposterior and lateral spinal radiographs were acquired preoperatively, after the first and second stages of surgery, and at the final follow-up. Using these radiographs and the Cobb technique [37] we measured the magnitude of the coronal major curve as well as spinal height (T1-S1) and space available for the lung [7,9,11]. T1-S1 length was measured as the distance from the midpoint of the T1 superior end plate to the midpoint of the S1 superior end plate.…”

Section: Radiographic Parametersmentioning

confidence: 99%

“…The surgical technique used was a modification of Buchowski's and Skaggs' methods of internal distraction, which are well-known in the literature [7][8][9][10][11]. Briefly, in the first stage of surgery, patients were placed in prone position after induction of general anesthesia with tracheal intubation.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Attention for signals and MAPs were kept at minimum 80 mmHg or higher during distraction. If there is a genuine NM event, prompt release of distraction should lead to immediate return of MEPs, and significant further distraction is contraindicated [11,[14][15][16]. Intraoperative NM change from baseline was defined as a 10% increase in latency and/or 50% decrease in SSEP amplitude or MEP absence, unilaterally or bilaterally [11,[13][14][15][16].…”

Section: Neuromonitoringmentioning

confidence: 99%

“…Temporary distraction rods provide a significant corrective force directly to the deformed spine to increase the possibility for safer correction manipulations working using the viscoelastic components of the human body. Due to all contraindications and complications of HALO gravity traction or VCR, temporary internal distraction is considered as an alternative to correct severe scoliosis [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Radiological Outcomes of Less Invasive Temporary Internal Distraction Followed by Staged Pedicle Screw Instrumentation in Adolescents with Severe Idiopathic Scoliosis at 2-Year Minimum Follow-Up

Grabala

Helenius

2020

World Neurosurgery

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Study Design. A single-center, retrospective study with a minimum 2-year follow up.Objectives. To describe and report the outcomes of minimal invasive temporary internal distraction (MI-TID) in the surgical treatment of adolescents with severe idiopathic scoliosis (SS).Summary of Background Data. Temporary internal distraction rod is one of the surgical options in severe scoliosis to avoid preoperative halo traction or vertebral column resection. This technique can be applied in a single session or staged and also using magnetically controlled growing rods to facilitate curve correction. Here we report the outcomes of simplistic initial minimal invasive internal distraction surgery followed by definitive segmental pedicle screw instrumentation with posterior column osteotomies.Methods. Twenty-two consecutive adolescents (19 girls, mean [SD] age 14.8 [2.0] years) with severe idiopathic scoliosis (major curve ≥ 90), who were treated using the MI-TID followed by staged pedicle screw instrumentation with minimum two-year follow-up. Demographic data, radiographic outcomes, pulmonary function tests (PFTs), perioperative data, Scoliosis Research Society 22 outcome questionnaire, complications, and neuromonitoring (NM) data were collected.Results. The major curve averaged preoperatively 120 (SD, 31°) and 58° (range 28°-65°) at final follow-up (p<0.001). Similarly, thoracic kyphosis (T5-T12) improved from 80 (42°) to 32° (range, 23°-68°) (p<0.001), and spinal height (T1-S1) increased from 332 mm (range, 198-432 mm) to 405 mm (range, 258-495 mm) (p<0.001). Five (23%) children had an intraoperative neuromonitoring change without postoperative neurologic deficits and two children developed superior mesenteric artery syndrome treated conservatively. Mean per cent predicted forced vital capacity (FVC) improved from 44.5% (11.3%) to 66.5 (10.8) at final follow-up(p<0.05).The SRS-22R total score improved significantly from 2.9 (0.61) to 4.1 (0.44) (p<0.05). Conclusion.Staged minimally invasive internal distraction followed by pedicle screw instrumentation is safe and effective in adolescents with severe idiopathic scoliosis improving spinal deformity, pulmonary function, and health-related quality.

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