Survivals of the Intraoperative Motor-evoked Potentials Response in Pediatric Patients Undergoing Spinal Deformity Correction Surgery

Background Despite the wide use of intraoperative neurophysiological monitoring (IONM) in spinal surgeries, the efficacy of IONM during percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) surgery in detecting postoperative neurological deficits has not been well characterized. Methods MIONM data from 113 consecutive patients who underwent PE-TLIF surgeries between June 2018 and April 2020 were retrospectively reviewed. Postoperative neurological deficits were documented and analyzed, and the efficacy and specificity of various IONM techniques were compared. Results Of the 113 consecutive patients, 12 (10.6%) with IONM alerts were identified. The MIONM sensitivity and specificity were 100 and 96.2%, respectively. The frequency of neurological complications, including minor deficits, was 6.2% (n = 7); all of the neurological complications were temporary. The ability of single IONM modalities to detect neurological complications varied between 25.0 and 66.6%, whereas that of all modalities was 100%. Conclusions MIONM is more effective and accurate than unimodal monitoring in assessing nerve root function during PE-TLIF surgeries, reducing both neurological complications and false-negative findings. We recommend MIONM in PE-TLIF surgeries.

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“…MEP: The warning standard was that the waveform completely disappeared or the amplitude decreased by 80% from baseline [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Roles of multimodal intra-operative neurophysiological monitoring (IONM) in percutaneous endoscopic transforaminal lumbar interbody fusion: a case series of 113 patients

Luo

Wang

Liu

et al. 2021

BMC Musculoskelet Disord

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“…MEP: The warning standard was that the waveform completely disappeared or the amplitude decreased by 80% from baseline [21]. SSEP: Continuous recording was compared to the baseline trajectory, and reductions in the amplitude by at least 50% or increases in the delay by 10% served as alarm criteria [22].…”

Section: Warning Criteriamentioning

confidence: 99%

Roles of Multimodal Intra-Operative Neurophysiological Monitoring (IONM) in Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: A Case Series of 113 Patients

Chen

Luo

Wang

et al. 2021

Preprint

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Background: Despite the widely used intra-operative neurophysiological monitoring (IONM) in spinal surgeries, the efficacy of IONM during percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) surgery in detecting post-operative neurological deficits has not been well characterized.Objective: To investigate the efficacy and specificity of multimodal IONM (MIONM) on the detection of neurological complications during PE-TLIF surgeries.Methods: Multimodal IONM data from 113 consecutive cases who underwent PE-TLIF surgeries betweenJune2018and April 2020 were retrospectively reviewed. Post-operative neurological deficits were documented and analyzed, and the efficacy and specificity of various IONM techniques were compared.Results: Of the 113 consecutive patients, we identified 12 (10.6%) IONM alerts. The multimodal IONM sensitivity and specificity were 100% and 96.2%, respectively. The frequency of neurological complications, including minor deficits, was 6.2% (n = 7), all of which were temporary. Analysis of single IONM modalities varied between 25.0% and 66.6% with respect to their abilities to detect neurological complications compared to 100% when using all modalities.Conclusions: Multimodal IONM is more effective and accurate in assessing nerve root function during PE-TLIF surgeries, reducing both neurological complications and false-negative findings compared to unimodal monitoring. We recommend multimodal IONM in PE-TLIF surgeries.

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“…Combining data from all 10 articles analyzed,7–16 1037 patients who underwent surgeries for spinal deformity correction were monitored, 137 (13.2%) of which had changes in IONM. Sixteen of 137 patients (11.7%) had a postoperative neurological deficit, 2 of whom had long-term sequelae.…”

Section: Review Of the Literaturementioning

confidence: 99%

Comprehensive Perioperative Approach to Complex Spine Deformity Management

Camargo

Abode-Iyamah²,

Shah³

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Objective: Study perioperative strategies for optimizing neuroprotection in complex spine deformity correction surgery. Methods: We report the case of a patient with severe lumbar dextroscoliosis, thoracolumbar junction hyperkyphosis with a 40-degree Cobb angle levoconvex scoliosis who underwent spinal deformity correction with loss of neuromonitoring during surgery. We performed a literature review on perioperative management of complex spine deformity. Results: A 50-year-old man presented with lumbar pain and right L4 radiculopathy. Surgical intervention for deformity correction and decompression was indicated with T4−L4 posterior instrumentation L2/L3 and L3/L4 transforaminal lumbar interbody fusion. Surgery was aborted due to the loss of neuromonitoring. Postsurgery, the patient had left sensory deficit and the neurocritical care team clinically suspected and deduced the anatomic location of the spinal cord compression. Magnetic resonance imaging confirmed a T10−T11 hyperintensity suggestive of cord ischemia due to osteophyte compressing the spinal cord. The patient underwent a second corrective surgery with no intraoperative events and has no long-term neurological sequela. Conclusions: This case illustrates that a comprehensive perioperative approach and individualized risk factor assessment is useful in complex spine deformity surgery. Further research is needed to determine how this individualized comprehensive approach can lead to intraoperative and postoperative countermeasures that improved spine surgery outcomes. Level of Evidence: Level V.

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Survivals of the Intraoperative Motor-evoked Potentials Response in Pediatric Patients Undergoing Spinal Deformity Correction Surgery

Cited by 8 publications

References 26 publications

Roles of multimodal intra-operative neurophysiological monitoring (IONM) in percutaneous endoscopic transforaminal lumbar interbody fusion: a case series of 113 patients

Roles of multimodal intra-operative neurophysiological monitoring (IONM) in percutaneous endoscopic transforaminal lumbar interbody fusion: a case series of 113 patients

Roles of Multimodal Intra-Operative Neurophysiological Monitoring (IONM) in Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: A Case Series of 113 Patients

Comprehensive Perioperative Approach to Complex Spine Deformity Management

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