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Efficacy of intraoperative monitoring for pediatric patients with spinal cord pathology undergoing spinal deformity
T J Wilson-Holden1, A M Padberg, L G Lenke
1Department of Orthopedic Surgery, Washington University Medical Center, St. Louis, Missouri, USA.
Insights
Intraoperative monitoring is valuable for pediatric spinal deformity surgery in patients with spinal cord pathology, despite higher variability and false-positive rates. This approach aids in detecting neurologic deficits during complex procedures.
Area of Science:
- Neurology
- Orthopedic Surgery
- Spinal Cord Pathology
Background:
- Intraoperative monitoring's value in spinal cord pathology is debated.
- Optimal monitoring protocols for this population are lacking.
Observation:
- A retrospective study analyzed 38 pediatric patients with spinal cord pathology undergoing corrective spinal deformity surgery.
- Somatosensory and neurogenic motor evoked potentials were used for intraoperative neurologic monitoring.
- Data were compared to 429 pediatric patients with idiopathic scoliosis.
Findings:
- Somatosensory evoked potentials were obtained in 93.2% of cases, with 87.2% remaining consistent.
- Neurogenic motor evoked potentials were obtained in 50.8%, with 76.6% consistency.
- The study group showed a 27.1% false-positive rate versus 1.4% in the idiopathic scoliosis group, with no true-positive or false-negative findings.
Implications:
- Intraoperative monitoring is recommended for pediatric spinal deformity surgery in patients with spinal cord pathology.
- Monitoring demonstrates greater variability, necessitating more frequent intraoperative wake-up tests.
- This monitoring can help identify neurologic deficits during surgery.
Study Design:
A retrospective study of 38 pediatric patients with spinal cord pathology who underwent corrective spinal deformity surgery from January 1989 through June 1998.
Objectives:
To report reliability and specificity in obtaining intraoperative data in this population. These data were compared with monitoring results obtained in a group of pediatric patients with idiopathic scoliosis.
Summary Of Background Data:
Reports in the literature suggest intraoperative monitoring for patients with spinal cord pathology may be of limited value. No optimal monitoring protocol has been suggested for this population.
Methods:
The study group consisted of 38 pediatric patients with a diagnosis of spinal cord pathology who underwent corrective spinal deformity surgery from January 1989 through June 1998. All patients had lower extremity function. Somatosensory and neurogenic motor evoked potentials were used to monitor neurologic status during surgery. These data were compared with data obtained in 429 pediatric patients with idiopathic scoliosis. Study patients were divided into Group I, those who had had spinal cord surgery (n = 20), and Group II, those who had not (n = 18).
Results:
Somatosensory evoked potentials were obtained in 93.2% and remained consistent with baselines in 87.2% of the study group patients. Neurogenic motor evoked potentials were obtained in 50.8% of the study subjects and remained consistent in 76.6% of those cases. The false-positive rate was 27.1% in the study group, compared with 1.4% in the group with idiopathic scoliosis. The study group had no true-positive or false-negative findings. Group I data differed from Group II data.
Conclusions:
Intraoperative monitoring should be used in patients with spinal cord pathology who undergo surgery for spinal deformity. Monitoring should not miss a neurologic deficit but demonstrates greater variability, resulting in more frequent use of an intraoperative wake-up test.
