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

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Neurophysiology

Background:

• Intraoperative monitoring of the spinal cord is standard for pediatric spinal deformity correction.
• Evoked potentials (somatosensory and motor) enhance detection of neurophysiological changes.
• This study details a large single-center experience with neuromonitoring changes.

Purpose of the Study:

• To report on neuromonitoring changes during pediatric spinal deformity surgery.
• To outline surgical management strategies for patients with significant neuromonitoring changes.
• To assess the effectiveness of intraoperative neuromonitoring in preventing spinal cord injury.

Main Methods:

• Retrospective review of 519 pediatric spinal deformity correction cases (Jan 2007-Mar 2010).
• Identification of 47 cases with significant changes in somatosensory or motor evoked potentials.
• Review of patient demographics and surgical characteristics for these 47 cases.

Main Results:

• Significant neuromonitoring changes occurred in 9.1% of cases (47/519).
• 100% sensitivity was observed for intraoperative neuromonitoring.
• Interventions included wake-up tests (79%), hardware adjustments (32%), and procedure abortion (28%).
• 4 out of 6 abnormal wake-up tests correlated with postoperative neurological deficits.

Conclusions:

• Intraoperative neurophysiological monitoring is essential for warning of potential spinal cord injury during surgery.
• Neuromonitoring serves as a safe and effective warning system to minimize spinal cord injury in pediatric scoliosis correction.
• Prompt surgical management based on neuromonitoring alerts is vital.