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Dermal Discolorations and Burns at Neuromonitoring Electrodes in Pediatric Spine Surgery
Austin Sanders1, Lindsay Andras1, Alison Lehman1
1Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Study Design:
Prospective review of consecutive patients.
Objective:
To evaluate the incidence and raise awareness of electrode discoloration that can occur in the operating room when using neuromonitoring.
Summary Of Background Data:
To our knowledge there are no articles that discuss dermal discolorations following spine surgery.
Methods:
Following recognition of dermal discolorations in some patients, a prospective evaluation of all patients undergoing spine surgery with somatosensory-evoked potential and motor-evoked potential neuromonitoring using subdermal needle electrodes was carried out over a 16-month period for quality assurance and improvement.
Results:
A total of 201 consecutive patients with mean age of 14 years (4-25) were prospectively evaluated. Sixteen percent (33/201) had dermal discolorations associated with neuromonitoring. There were no significant differences in mean age (P = 0.624), height (P = 0.308), weight (P = 0.899), or body mass index (P = 0.571) between the patients with and without dermal discolorations. There was also no difference in prevalence of dermal discoloration by diagnosis (P = 0.490) or location of grounding pad and occurrence of dermal discoloration between groups (P = 0.268). The only difference noted was that patients without dermal discoloration had an average monopolar cautery setting of 46.8 W compared to 40.5 W for patients with dermal discolorations (P = 0.042). Of the 33 patients with a dermal discoloration, 27% (9/33) of these were on both the upper and lower extremities, 21% (7/33) on only the upper extremities, and 52% (17/33) on only the lower extremities. None of the dermal discolorations were painful or tender, and all resolved by 6-month follow-up. One patient did not have any dermal discoloration but did experience two full-thickness burns around the electrodes in one leg. The incidence of burns in this series was 0.5% (1/201).
Conclusion:
Dermal discolorations occurred in 16% of patients undergoing neuromonitoring for spine surgery. These common discolorations were painless and resolved by 6 months. More significant burns were uncommon, occurring in less than 1%.
Level Of Evidence:
3.
