Intraoperative neurophysiologic monitoring in idiopathic scoliosis surgery: a retrospective observational study of new neurologic deficits

Abstract

Purpose Patients with adolescent idiopathic scoliosis undergoing corrective surgery are at risk for iatrogenic spinal cord injury and subsequent new neurologic deficits (NNDs). Intraoperative neurophysiologic monitoring (IONM) has been used to identify spinal cord injury; however, available data showing that IONM leads to improved clinical outcomes are inconclusive. This exploratory study aimed to examine the incidence of NNDs after idiopathic scoliosis surgery in two pediatric institutions in Canada with a focus on IONM use. Methods Charts of pediatric patients (10-18 yr) with adolescent idiopathic scoliosis who underwent scoliosis correction surgery were retrospectively identified from the This article is accompanied by an editorial. Can J Anesth 2021; this issue.

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2021

“…Nassef et al conducted a retrospective exploratory study to examine the incidence and severity of NNDs after idiopathic scoliosis surgery with a focus on IONM use. 12 In addition, they compared the incidence of NND before and after the implementation of IONM. They reviewed the charts of 547 patients aged 10-18 years old from two large tertiary pediatric centers; of these, 359 patients were monitored by IONM and 186 patients were monitored by wake-up test (Pre IONM).…”

Intraoperative neuromonitoring for scoliosis surgery: is there an end to justify the means?

“…In this issue of the Journal, Nassef et al reported a retrospective before-and-after study to compare the effect of the Stagnara wake-up test with evoked potentials (EP) monitoring on postoperative neurologic deficits in 547 adolescent patients (10-18 yr old) who underwent scoliosis correction surgery in two Canadian institutions between 2007 and 2014. 6 Both institutes transitioned their neurologic monitoring technique from the Stagnara wakeup test to EP monitoring around 2009/2010. In their analysis, the authors found that the patients who received intraoperative neuromonitoring were less likely to develop postoperative neurologic deficits compared with those who underwent the Stagnara wake-up test (odds ratio, 0.39; 95% confidence interval, 0.18 to 0.86; P = 0.020).…”

“…The authors concluded multimodal intraoperative neuromonitoring (SSEPs and MEPs) is associated with reduced overall incidence of new neurologic deficits, although they were not able to adjust for confounding variables. 6 Given the paucity of evidence describing the role of neurologic monitoring and neurologic outcomes in spine surgery, the authors should be commended for undertaking this study and sharing their experience. This study represents one of very few cohorts in the literature in which a direct head-tohead outcome comparison was made between these two intraoperative neurologic monitoring techniques in scoliosis surgery.…”

“…rapportent les conclusions d'une étude rétrospective avant-après comparant l'effet du test d'éveil de Stagnara au monitorage des potentiels évoqués (PE) sur les déficits neurologiques postopératoires chez 547 patients adolescents (âgés de 10 à 18 ans) ayant subi une chirurgie de correction de scoliose dans deux établissements canadiens entre 2007 et 2014. 6 Les deux institutions ont modifié leur technique de monitorage neurologique en faisant la transition du test d'éveil de Stagnara au monitorage des PE vers 2009/2010. Dans leur analyse, les auteurs ont constaté que les patients ayant reçu un neuro-monitorage peropératoire étaient moins susceptibles de développer des déficits neurologiques postopératoires comparés à ceux ayant subi un test d'éveil de Stagnara (rapport de cotes, 0,39; intervalle de confiance de 95 %, 0,18 à 0,86; P = 0,020).…”

“…Les auteurs concluent que le neuro-monitorage peropératoire multimodal (PES et PEM) est associé à une réduction de l'incidence globale des nouveaux déficits neurologiques, bien qu'ils n'aient pas été en mesure d'ajuster leurs résultats pour tenir compte des variables confondantes. 6 É tant donné le manque de données probantes décrivant le rôle du monitorage neurologique et des pronostics neurologiques dans la chirurgie du rachis, il convient de féliciter les auteurs pour avoir entrepris cette étude et partagé leur expérience. Cette étude représente l'une des très rares cohortes dans la littérature dans laquelle une comparaison directe des résultats a été réalisée entre ces deux techniques de monitorage neurologique peropératoire lors d'une chirurgie de scoliose.…”