A modified wake-up test for use in very young children undergoing spinal surgery

Area of Science:

• Pediatric spinal surgery
• Neurologic monitoring
• Intraoperative testing

Background:

• Hemivertebrectomy and fusion are complex spinal surgeries in children.
• Maintaining neurologic integrity during these procedures is critical.
• Current monitoring methods may have limitations.

Purpose of the Study:

• To evaluate a modified intraoperative wake-up test for assessing neurologic integrity in young children undergoing spinal surgery.
• To determine the feasibility and preliminary efficacy of using electrical stimulation during wake-up tests.

Main Methods:

• A modified intraoperative wake-up test was employed in five young children undergoing hemivertebrectomy and fusion.
• Tetanic electrical stimulation was applied to the plantar aspect of each foot using standard leads and a nerve stimulator.
• Neurologic responses were assessed during the wake-up phase.

Main Results:

• Four out of five children demonstrated vigorous motor responses (knee and ankle flexion/extension) with minimal delay.
• One neurologically intact child did not respond due to technical issues.
• The technique was found to be feasible in this small cohort.

Conclusions:

• The modified intraoperative wake-up test using electrical stimulation appears to be a favorable preliminary technique for confirming neurologic integrity in pediatric spinal surgery.
• Further investigation is warranted to refine the technique and address potential technical challenges.
• This method offers a potential adjunct for intraoperative neuromonitoring in pediatric spinal deformity correction.