The SCARE Score: A Simplified Risk Score for Predicting Intraoperative Neuromonitoring Signal Loss in Pediatric...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Medical Technology

Background:

• Pediatric spinal deformity surgery carries a risk of neurological injury.
• Intraoperative neuromonitoring (IONM) assesses neurological status in real-time.
• Predicting IONM signal loss is crucial for patient safety.

Purpose of the Study:

• To identify preoperative factors associated with IONM signal loss.
• To develop a risk-assessment score for IONM signal loss.
• To aid surgeons in predicting patient risk for IONM signal loss.

Main Methods:

• Retrospective analysis of prospectively collected data from 360 patients undergoing 413 surgeries.
• Univariate and multivariable analysis of preoperative demographic data.
• Development and internal validation of a simplified clinical risk score (SCARE).

Main Results:

• IONM signal loss occurred in 24% of patients.
• The SCARE score incorporates Spinal Cord morphology, Angular ratio, Revision surgery, and syndromic Etiology.
• Risk stratification (low, moderate, high) showed increasing IONM event rates with higher scores (3.3%–59.7%).

Conclusions:

• The SCARE score is a validated, simple preoperative tool for predicting IONM signal loss risk.
• This score can assist in surgical planning and perioperative discussions.
• Further external validation is needed to enhance its utility in pediatric spinal deformity surgery.