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Intraoperative neurophysiology monitoring in scoliosis surgery in children

Lakshmi Nagarajan1,2,3, Soumya Ghosh1,4, David Dillon5

  • 1Children's Neuroscience Service, Dept. of Neurology, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.

Clinical Neurophysiology Practice
|March 5, 2019
PubMed

Insights

Intraoperative neurophysiology monitoring (INM) helps reduce neurological deficits in pediatric scoliosis surgery. This study recommends specific alert criteria and total intravenous anesthesia for safer INM procedures.

Area of Science:

  • Neurosurgery
  • Pediatric Orthopedics
  • Anesthesiology

Background:

  • Intraoperative neurophysiology monitoring (INM) is increasingly used in pediatric scoliosis and spine deformity surgery to prevent neurological deficits.
  • However, its effectiveness is debated due to varied results, non-standardized alarm criteria, and cost concerns.

Purpose of the Study:

  • To present the authors' experience with INM in pediatric scoliosis and spine deformity surgery.
  • To propose specific alert criteria for INM.
  • To recommend preferred anesthetic agents for INM during these procedures.

Main Methods:

  • A retrospective analysis of 56 children undergoing 61 scoliosis and spine deformity surgeries with INM.
  • Monitoring utilized transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials.
  • Data on alerts, postoperative deficits, and anesthetic types were collected.

Main Results:

  • INM was successfully performed without any associated injuries.
  • Five alerts occurred in four surgeries across four children.
  • Only one child experienced a postoperative deficit; no new deficits were observed in children without alerts.
  • Total intravenous anesthesia demonstrated better outcomes for INM compared to inhalational anesthetics.

Conclusions:

  • INM is a valuable tool in pediatric scoliosis surgery, likely reducing the risk of new postoperative neurological deficits.
  • Recommended TcMEP alert criteria encompass amplitude, stimulus paradigm, and morphology.
  • Propofol and remifentanil are recommended as preferred anesthetic agents over sevoflurane and remifentanil for INM.
Abstract

Keywords:
ChildrenIntraoperative neurophysiology monitoringScoliosis surgerySomatosensory evoked potentialsTotal intravenous anaesthesiaTranscranial electrical stimulation evoked motor potentials

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