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Updated: Mar 23, 2026
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Intraoperative spinal cord monitoring in children under 4 years old
Martine Gavaret1,2, Sébastien Pesenti3,4, Elie Choufani3,4
1AP-HM, Service de Neurophysiologie Clinique, Hôpital de la Timone, 264 rue Saint Pierre, 13005, Marseille, France. martine.gavaret@ap-hm.fr.
Insights
Intraoperative spinal cord monitoring (IOM) in children under 4 years old with congenital spinal deformities shows high sensitivity (86%) and specificity (96%). Experienced neurophysiologists are recommended for this challenging pediatric population.
Area of Science:
- Pediatric Neurosurgery
- Neurophysiology
- Spinal Deformity Correction
Background:
- Intraoperative spinal cord monitoring (IOM) presents unique challenges in young children (<4 years) due to immature sensory-motor pathways.
- This study addresses the largest cohort to date investigating IOM in this specific pediatric demographic.
Purpose of the Study:
- To evaluate the particularities and performance of intraoperative spinal cord monitoring (IOM) in children under 4 years old undergoing surgery for congenital spinal deformities.
- To assess the diagnostic accuracy of IOM in this vulnerable patient group.
Main Methods:
- A retrospective, monocentric analysis of 78 intraoperative spinal cord monitoring (IOM) procedures in children under 4 years old.
- Utilized somatosensory evoked potentials (SSEP), neurogenic mixed evoked potentials (NMEP), and D waves.
- Calculated sensitivity and specificity based on IOM data and clinical outcomes (true positive, false positive, true negative, false negative).
Main Results:
- Achieved high diagnostic accuracy with 86% sensitivity and 96% specificity for IOM.
- Identified 6 true positive, 3 false positive, 67 true negative, and 1 false negative outcome.
- Neurogenic mixed evoked potentials (NMEP) demonstrated a superior signal-to-noise ratio compared to somatosensory evoked potentials (SSEP).
Conclusions:
- Immaturity of central sensory-motor pathways significantly impacts IOM in young children, potentially affecting motor evoked potentials (MEP) and D waves.
- Neurogenic mixed evoked potentials (NMEP) offer a valuable alternative to bypass central pathways.
- Intraoperative spinal cord monitoring (IOM) in this population requires experienced neurophysiologists and careful consideration of maturational factors, advising against surgeon-guided devices.
Purpose:
The purpose was to study intraoperative spinal cord monitoring (IOM) particularities and performances in children under 4 years old with congenital spinal deformities. IOM is characterized by specific difficulties due to the immaturity of sensory-motor pathways in such young patients. To the best of our knowledge, this study is the largest dedicated to IOM in this challenging population.
Methods:
This study was retrospective and monocentric. 78 IOM in children under 4 years old were analyzed. Somatosensory evoked potentials (SSEP), neurogenic mixed evoked potentials (NMEP) and D waves were performed. Patients were classified into one of four categories with respect to IOM data and clinical outcome: true positive, false positive, true negative and false negative. Sensitivity and specificity were then calculated accordingly.
Results:
There were 6 true positive, 3 false positive, 67 true negative and 1 false negative outcomes. One patient was characterized by unreliable baseline IOM data. IOM sensitivity was 86 %. IOM specificity was 96 %. The false negative case was monitored using SSEP alone. IOM was difficult in 10/77 cases, being unilateral because of a planned fibular graft harvest. NMEP were characterized by higher signal-to-noise ratio than SSEP.
Conclusions:
Immaturity of sensory-motor pathways predominates in the central rather than the peripheral nervous system in young children. MEP and D waves could thus be difficult to obtain. Although non-specific to motor pathways, it could be useful to "by-pass" the brain, using NMEP. In regard to maturational particularities, IOM in children under 4 years old should be performed by experienced neurophysiologists, avoiding in these cases surgeon-guided devices.
