Related Experiment Video
Updated: Jan 24, 2026
05:53
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
5.3K
Responding to Intraoperative Neuromonitoring Changes During Pediatric Coronal Spinal Deformity Surgery
Stephen J Lewis1,2, Ian H Y Wong1, Samuel Strantzas1
1Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Global Spine Journal
|June 4, 2019
Summary
Intra-operative neuromonitoring (IONM) alerts during pediatric spinal deformity surgery can indicate spinal cord injury. Differentiating between perfusion deficits and direct trauma allows for targeted interventions, ensuring safe surgical correction with no new neurological deficits.
Area of Science:
- Neurosurgery
- Orthopedics
- Neurology
Background:
- Intra-operative neuromonitoring (IONM) is crucial for detecting potential spinal cord injury during complex spinal surgeries.
- Pediatric spinal deformity correction carries inherent risks of neurological compromise.
Purpose of the Study:
- To detect spinal cord injury patterns via IONM changes in pediatric spinal deformity correction.
- To differentiate between perfusion-based and direct trauma causes of IONM changes.
- To observe intervention effects and develop treatment algorithms for IONM alerts.
Main Methods:
- Retrospective analysis of prospectively collected IONM data from pediatric patients undergoing spinal deformity surgery.
- Categorization of IONM alerts into unilateral (direct trauma) and bilateral (perfusion deficit) changes.
- Review of interventions and outcomes following alert management.
Main Results:
- 27.8% incidence of IONM alerts in 97 pediatric patients.
- Bilateral changes responded to transfusion, blood pressure management, and rod removal.
- Unilateral changes improved upon removal of the causative agent (e.g., during osteotomy).
- All cases completed successfully with no new neurological deficits post-intervention.
Conclusions:
- Differentiating IONM alert causes (perfusion vs. direct trauma) enables targeted interventions for safe spinal deformity correction.
- Complete return of IONM signal to baseline is not necessary for a normal neurological outcome.
Keywords:
Brown-Sequard syndromeanemiaanterior cord syndromeincomplete spinal cord injuriesmotor evoked potentialsneuromonitoringpediatricperfusionscoliosistransfusionMore Related Videos
Related Concept Videos
01:19Plastic Deformations
442
Plastic deformation represents a fundamental concept in materials science, which explains the irreversible change in the shape of a material when it experiences stress beyond its elastic capability. This phenomenon is important in structural engineering, especially in designing and analyzing cantilever beams—structures that are securely fixed at one end and bear loads at the opposite end. When these beams are subjected to loads within their elastic range, they will return to their...
442
01:14Plastic Deformations
412
It is essential to understand how structural members behave under plastic deformation when the bending stress exceeds the material's yield strength. This state of deformation permanently alters the shape of the member, in contrast to the linear elastic behavior observed before yielding. The strain at any point in the member is expressed in terms of maximum strain. Notably, the neutral axis, which coincides with the centroid during elastic bending, shifts away from the centroid under plastic...
412
01:12Temperature Dependent Deformation
374
In a nonhomogeneous rod made up of steel and brass, restrained at both ends and subjected to a temperature change, several steps are involved in calculating the stress and compressive load. Due to the problem's static indeterminacy, one end support is disconnected, allowing the rod to experience the temperature change freely. Next, an unknown force is applied at the free end, triggering deformations in the rod's steel and brass portions. These deformations are then calculated and added...
374
01:18Deformations in a Symmetric Member in Bending
485
When analyzing the deformation of a symmetric prismatic member subjected to bending by equal and opposite couples, it becomes clear that as the member bends, the originally straight lines on its wider faces curve into circular arcs, with a constant radius centered at a point known as Point C. This phenomenon helps to understand the stress and strain distribution within the member more clearly.
When the member is segmented into tiny cubic elements, it is observed that the primary stress...
When the member is segmented into tiny cubic elements, it is observed that the primary stress...
485
01:11Deformation of Member under Multiple Loadings
454
When a rod is made of different materials or has various cross-sections, it must be divided into parts that meet the necessary conditions for determining the deformation. These parts are each characterized by their internal force, cross-sectional area, length, and modulus of elasticity. These parameters are then used to compute the deformation of the entire rod.
In the case of a member with a variable cross-section, the strain is not constant but depends on the position. The deformation of an...
In the case of a member with a variable cross-section, the strain is not constant but depends on the position. The deformation of an...
454
01:10Deformation in a Circular Shaft
880
One of the distinctive characteristics of circular shafts is their ability to maintain their cross-sectional integrity under torsion. In other words, each cross-section continues to exist as a flat, unaltered entity, simply rotating like a solid, rigid slab. To understand the distribution of shearing stress within such a shaft, consider a cylindrical section inside this circular shaft. This section has a length of L and a radius of R, with one end fixed. The radius of the cylindrical section is...
880