TY - JOUR
T1 - What is the frequency of intraoperative alerts during pediatric spinal deformity surgery using current neuromonitoring methodology? A retrospective study of 218 surgical procedures
AU - Polly, David W.
AU - Rice, Kent
AU - Tamkus, Arvydas
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Introduction: There is variability in intraoperative neuromonitoring (IONM), anesthetic and surgical techniques for the treatment of pediatric spinal deformity. This study evaluates a series of patients treated at multiple centers utilizing transcranial motor and somatosensory evoked potentials (TcMEP and SSEP) and electromyography (EMG). The frequency of alerts and the intraoperative follow-up is reported. Methods: Standard patient demographics and IONM data were collected from a two-month cohort of pediatric spine deformity cases. Results: Data from 218 scoliosis patients were included from 46 facilities and 72 surgeons. Baseline upper and lower extremity TcMEP data were present in 96.7% and 93.9% patients respectively. Baseline upper and lower SSEPs were present in 99.5% and 95.4% respectively. Surgical TCMEP alerts occurred in 19 (8.7%) patients during deformity correction (n = 11), placement of instrumentation (n = 5), decompression (n = 2), and closing (n = 1) with concurrent SSEP alerts occurring in five patients. Nine had TCMEP recovery, eight showed partial recovery and two did not recover. Additional alerts occurred due to: positioning (n = 16), inhalational agent change (n = 4), global physiological change (n = 4) and technical reasons (n = 2). A total of 2164 pedicle screws were tested. Of 197 (9.1%) screws that tested from 6-9 mA, 171 (65.4%) were left unchanged, 10 (5.1%) removed, eight (4.1%) repositioned with improved threshold, and eight (4.1%) without improvement. Of 26 screws that tested ≤5 milliamperes (mA), 17 (65.4%) were left unchanged, five (19.2%) removed, two (7.7%) repositioned with improved threshold, and two (7.7%) without improvement. Conclusions: IONM provides data that causes re-evaluation in about 10% of pediatric spinal deformity cases.
AB - Introduction: There is variability in intraoperative neuromonitoring (IONM), anesthetic and surgical techniques for the treatment of pediatric spinal deformity. This study evaluates a series of patients treated at multiple centers utilizing transcranial motor and somatosensory evoked potentials (TcMEP and SSEP) and electromyography (EMG). The frequency of alerts and the intraoperative follow-up is reported. Methods: Standard patient demographics and IONM data were collected from a two-month cohort of pediatric spine deformity cases. Results: Data from 218 scoliosis patients were included from 46 facilities and 72 surgeons. Baseline upper and lower extremity TcMEP data were present in 96.7% and 93.9% patients respectively. Baseline upper and lower SSEPs were present in 99.5% and 95.4% respectively. Surgical TCMEP alerts occurred in 19 (8.7%) patients during deformity correction (n = 11), placement of instrumentation (n = 5), decompression (n = 2), and closing (n = 1) with concurrent SSEP alerts occurring in five patients. Nine had TCMEP recovery, eight showed partial recovery and two did not recover. Additional alerts occurred due to: positioning (n = 16), inhalational agent change (n = 4), global physiological change (n = 4) and technical reasons (n = 2). A total of 2164 pedicle screws were tested. Of 197 (9.1%) screws that tested from 6-9 mA, 171 (65.4%) were left unchanged, 10 (5.1%) removed, eight (4.1%) repositioned with improved threshold, and eight (4.1%) without improvement. Of 26 screws that tested ≤5 milliamperes (mA), 17 (65.4%) were left unchanged, five (19.2%) removed, two (7.7%) repositioned with improved threshold, and two (7.7%) without improvement. Conclusions: IONM provides data that causes re-evaluation in about 10% of pediatric spinal deformity cases.
KW - Electromyography
KW - Intraoperative neuromonitoring
KW - Pediatric deformity
KW - Somatosensory evoked potentials
KW - Transcranial motor evoked potentials
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U2 - 10.1080/21646821.2015.1119022
DO - 10.1080/21646821.2015.1119022
M3 - Article
C2 - 27180504
AN - SCOPUS:84964355595
SN - 2164-6821
VL - 56
SP - 17
EP - 31
JO - Neurodiagnostic Journal
JF - Neurodiagnostic Journal
IS - 1
ER -