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

Clinical article

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  • 1 Department of Orthopedic Surgery, Shriners Hospital for Children, Philadelphia, Pennsylvania; and
  • | 2 Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
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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.

Abbreviations used in this paper:

IONM = intraoperative neuromonitoring; MEP = motor evoked potential; NMEP = neurogenic mixed evoked potential; SSEP = somatosensory evoked potential; tcMEP = transcranial MEP.

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  • 1

    Accadbled F, , Henry P, , de Gauzy JS, & Cahuzak J: Spinal cord monitoring in scoliosis surgery using an epidural electrode. Results of a prospective, consecutive series of 191 cases. Spine (Phila Pa 1976) 31:26142623, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Hamilton D, , Smith J, , Sansur C, , Glassman S, , Ames C, & Berven S, et al.: Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 36:12181228, 2011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Hart ES, & Grottkau BE: Intraoperative neuromonitoring in pediatric spinal deformity surgery. Orthop Nurs 28:286292, 2009

  • 4

    Kamerlink JR, , Errico T, , Xavier S, , Patel A, , Patel A, & Cohen A, et al.: Major intraoperative neurologic monitoring deficits in consecutive pediatric and adult spinal deformity patients at one institution. Spine (Phila Pa 1976) 35:240245, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Kundnani VK, , Zhu L, , Tak H, & Wong H: Multimodal intraoperative neuromonitoring in corrective surgery for adolescent idiopathic scoliosis: evaluation of 354 consecutive cases. Indian J Orthop 44:6472, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Noonan K, , Walker T, , Feinberg J, , Nagel M, , Didelot W, & Lindseth R: Factors related to false- versus true-positive neuromonitoring changes in adolescent idiopathic scoliosis surgery. Spine (Phila Pa 1976) 27:825830, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Othman Z, , Lenke LG, , Bolon SM, & Padberg A: Hypotension-induced loss of intraoperative monitoring data during surgical correction of Scheuermann kyphosis: a case report. Spine (Phila Pa 1976) 29:E258E265, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Padberg AM, Electrophysiology. DeWald RL: Spinal Deformities: The Comprehensive Text New York, Thieme, 2004. 135148

  • 9

    Padberg AM, , Wilson-Holden TJ, , Lenke LG, & Bridwell KH: Somatosensory- and motor-evoked potential monitoring without a wake-up test during idiopathic scoliosis surgery. An accepted standard of care. Spine (Phila Pa 1976) 23:13921400, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Pahys JM, , Guille JT, , D'Andrea LP, , Samdani AF, , Beck J, & Betz RR: Neurologic injury in the surgical treatment of idiopathic scoliosis: guidelines for assessment and management. J Am Acad Orthop Surg 17:426434, 2009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Pelosi L, , Lamb J, , Grevitt M, , Mehdian SM, , Webb JK, & Blumhardt LD: Combined monitoring of motor and somatosensory evoked potentials in orthopaedic spinal surgery. Clin Neurophysiol 113:10821091, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Schwartz DM, , Auerbach JD, , Dormans JP, , Flynn J, , Drummond DS, & Bowe JA, et al.: Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am 89:24402449, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Thuet ED, , Winscher JC, , Padberg AM, , Bridwell KH, , Lenke LG, & Dobbs MB, et al.: Validity and reliability of intraoperative monitoring in pediatric spinal deformity surgery: a 23-year experience of 3436 surgical cases. Spine (Phila Pa 1976) 35:18801886, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Vauzelle C, , Stagnara P, & Jouvinroux P: Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop Relat Res 93 173178, 1973

    • Search Google Scholar
    • Export Citation
  • 15

    Vitale MG, , Moore DW, , Matsumoto H, , Emerson RG, , Booker WA, & Gomez JA, et al.: Risk factors for spinal cord injury during surgery for spinal deformity. J Bone Joint Surg Am 92:6471, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Wilson-Holden T, , Padberg A, , Lenke L, , Larson B, , Bridwell K, & Bassett G: Efficacy of intraoperative monitoring for pediatric patients with spinal cord pathology undergoing spinal deformity surgery. Spine (Phila Pa 1976) 24:16851692, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation

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