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

Ferguson, Joseph; Hwang, Steven W.; Tataryn, Zachary; Samdani, Amer F.

doi:10.3171/2013.12.peds13188

Cited by 47 publications

(52 citation statements)

References 16 publications

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“…5 Multimodality neuromonitoring of SSEPs and TceMEPs allows for a greater level of specificity regarding patient outcome after spinal deformity surgery. 2 Nuwer et al observed a sensitivity level of 92% and a specificity level of 98% for SSEP monitoring, in terms of new postoperative motor deficits.…”

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confidence: 99%

“…1 Last, neurological disorders, such as seizures, were once thought to be a contraindication to TceMEPs. [1][2][3]8 According to MacDonald and colleagues, the incidence of seizures was 0.03% and the incidence of bite injuries was 0.2%. 6 Therefore, a risk/benefit analysis should be performed prior to utilizing TceMEPs.…”

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confidence: 99%

“…First, the small computerized averaged response lacks immediate feedback through data collection. 2 Second, SSEPs do not reveal the integrity of motor tracts. 2 Third, there may be a delay in response time.…”

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confidence: 99%

“…2 The dorsal columns are located in the posterior two-thirds of the spinal cord, and blood is supplied by 2 posterior spinal arteries. 4 Three limitations of SSEP monitoring exist.…”

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confidence: 99%

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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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confidence: 99%

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confidence: 99%

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confidence: 99%

“…2 The dorsal columns are located in the posterior two-thirds of the spinal cord, and blood is supplied by 2 posterior spinal arteries. 4 Three limitations of SSEP monitoring exist.…”

mentioning

confidence: 99%

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Intraoperative neuromonitoring alerts in a pediatric deformity center

Zuccaro¹,

Zuccaro²,

Samdani

et al. 2017

Neurosurgical Focus

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“…Studies of IOM in spinal deformity surgery reported an end result occurrence (postoperative deficit) of less than 1%. Hence, it was natural that specificity of IOM was around 99% and sensitivity varied according to wake-up test result [2,14]. Meanwhile, in the surgery for intramedullary tumour, at which postoperative neurologic deficit occur at higher rate and wake-up test is rarely applicable, the sensitivity is still high but specificity comes out less accurately.…”

Section: Predictability Of Mep and Ssep For Postoperative Motor Deficitmentioning

confidence: 99%

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

Kang¹,

Gwak²,

Shin³

et al. 2016

J Spine

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Objectives: To evaluate the feasibility, sensitivity and specificity of IOM for IDEM and ED metastatic spinal tumours, and to assess usefulness of SSEP for patients in whom MEP was not measurable. Methods and materials:One hundred and one consecutive patients with IDEM and ED metastatic spinal tumours at the cord level (C1 to L1) received surgery under SSEP and/or MEP was included. Feasibility of IOM was defined to be negative in case of no measurable MEP or SSEP under general anaesthesia after confirmation of reversal of neuromuscular block. More than 50% change of MEP or SSEP amplitude and more than 10% delay of SSEP latency were evaluated as positive signs of IOM change.Results: MEP was measurable in 74 out of 101 trials, thus feasibility is 73%. Patient with normal motor power showed higher feasibility than those with motor power 3 or less. (93% vs. 39%) Among 74 patients with measurable MEP, 19 patients showed positive MEP change and 14 patients got worse of their motor power postoperatively.

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