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Spinal Cord Monitoring Data in Pediatric Spinal Deformity Patients With Spinal Cord Pathology
Alexander W Aleem1, Earl D Thuet2, Anne M Padberg2
1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Insights
Intraoperative spinal cord monitoring (IOM) is effective in pediatric spinal surgery for patients with spinal cord pathology, offering valuable data for detecting functional changes and preventing deficits.
Area of Science:
- Pediatric Neurosurgery
- Spinal Surgery
- Neuromonitoring
Background:
- Spinal cord pathology affects 3-20% of pediatric scoliosis patients.
- Intraoperative spinal cord monitoring (IOM) is reliable in these cases.
- This study reviews IOM efficacy in pediatric spinal cord pathology.
Purpose of the Study:
- To evaluate the efficacy of monitoring data and outcomes in pediatric patients with spinal cord pathology undergoing spinal surgery.
Main Methods:
- Retrospective review of 119 spinal surgeries in 82 pediatric patients with spinal cord pathology.
- Diagnoses included Arnold-Chiari malformation, syringomyelia, myelomeningocele, spinal cord tumor, tethered cord, and diastematomyelia.
- Compared outcomes and data reliability with 82 adolescent idiopathic scoliosis (AIS) patients.
Main Results:
- Usable IOM data obtained in 82% of cases.
- Arnold-Chiari malformation and syringomyelia showed higher data reliability (p < .0001).
- No permanent neurologic deficits occurred; sensitivity 80%, specificity 92%.
Conclusions:
- IOM is valuable for detecting spinal cord function changes in pediatric spinal deformity surgeries.
- Arnold-Chiari and syringomyelia patients yield reliable IOM data, similar to AIS patients.
- Lower threshold for wake-up tests is advised for other spinal pathologies due to less reliable data.
Study Design:
Retrospective.
Objectives:
The purpose of this study is to review the efficacy of monitoring data and outcomes in pediatric patients with spinal cord pathology.
Summary Of Background Data:
The incidence of spinal cord pathology in pediatric patients with scoliosis has been reported between 3% and 20%. Previous studies demonstrated that intraoperative spinal cord monitoring (IOM) during scoliosis surgery can be reliable despite underlying pathology.
Methods:
A single-center retrospective review of 119 spinal surgery procedures in 82 patients with spinal cord pathology was performed. Diagnoses included Arnold-Chiari malformation, syringomyelia, myelomeningocele, spinal cord tumor, tethered cord, and diastematomyelia. Baseline neurologic function and history of prior neurosurgical intervention were identified. Outcome measures included ability to obtain reliable monitoring data during surgery and presence of postoperative neurologic deficits. Results were compared for 82 patients with adolescent idiopathic scoliosis (AIS).
Results:
Usable IOM data were obtained in 82% of cases (97/119). Twenty-two cases (18%) had no lower extremity data. Patients with Arnold-Chiari malformation or syringomyelia pathologies, in isolation or together, had a significantly higher rate of reliable data compared to other pathologies (p < .0001). Among study group cases with usable data, there were 1 false negative (1%) and 4 true positive (4%) outcomes. There were no permanent neurologic deficits. The spinal cord pathology group demonstrated 80% sensitivity and 92% specificity.
Conclusions:
Spinal cord monitoring is a valuable tool in pediatric patients with spinal cord pathology undergoing spinal deformity surgeries. When obtained, data allow to detect changes in spinal cord function. Patients with a diagnosis of Arnold-Chiari or syringomyelia have monitoring data similar to those patients with AIS. Patients with other spinal cord pathologies have less reliable data, and surgeons should have a lower threshold for performing wake-up tests to assess spinal cord function intraoperatively.
