What Is the Frequency of Intraoperative Alerts During Pediatric Spinal Deformity Surgery Using Current Neuromonitoring Methodology? A Retrospective Study of 218 Surgical Procedures

Polly, David W.; Rice, Kent S.; Tamkus, Arvydas

doi:10.1080/21646821.2015.1119022

Cited by 19 publications

(6 citation statements)

References 24 publications

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“…[9] In previous studies in patients undergoing scoliosis surgery, the incidence of a significant intraoperative monitoring change has been reported to occur from 3.6% to 8.7%. [13][14][15] We recognised an increased incidence of 11.8% for intraoperative neuromonitoring changes. In this study, we assessed patients undergoing high-risk spinal surgery, where 71% of patients had pre-operative neurological deficits.…”

Section: Discussionmentioning

confidence: 93%

The influence of anaesthesia on intraoperative neuromonitoring changes in high-risk spinal surgery

Royan

Manninen

et al. 2017

Journal of Neuroanaesthesiology and Critical Care

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Background: The use of intraoperative neuromonitoring is a well-established method of detecting neurologic injuries during spine surgery. Anaesthesia, especially inhalational agents, influence motor evoked potential (MEP) monitoring. The aim of our study was to compare the effect of balanced anaesthesia (BA) (intravenous plus inhalational anaesthesia) and total intravenous anaesthesia (TIVA) on the incidence of intraoperative neuromonitoring changes, interventions performed and neurological outcomes of patients following high-risk spinal surgery. Methods: After Research and Ethics Board approval, a retrospective review of 155 patients who underwent spinal surgery with MEP was performed. Data were collected on changes in MEP and/or somatosensory evoked potential, interventions performed and neurological outcomes. Patients were divided into BA and TIVA groups and data were analysed. Results: A total of 152 patients were eligible for the study (mean age 54 ± 17, male: female 45:55). A BA technique was used in 62% and TIVA in 38%. Desflurane (<0.5 minimum alveolar concentration [MAC]) was used in 85% BA cases. Intraoperative neuromonitoring changes occurred in 11.8% (18/152) of cases. There was no statistical difference in the incidence of monitoring changes between BA (78%) and TIVA (22%) groups (P = 0.197). Anaesthetic or surgical interventions were performed in 12 patients, with a resolution of changes in 50% (P = 0.455). All 5 patients with persistent MEP changes had worsening of existing neurological deficits postoperatively; 8 had transient MEP changes, and 2 experienced worsening of existing neurological deficits. Conclusions: We found that intraoperative neurophysiological monitoring can be performed with both BA (MAC <0.5) and TIVA in high-risk spinal surgery with no statistical difference in the incidence of intraoperative monitoring changes.

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Section: Discussionmentioning

confidence: 93%

The influence of anaesthesia on intraoperative neuromonitoring changes in high-risk spinal surgery

Royan

Manninen

et al. 2017

Journal of Neuroanaesthesiology and Critical Care

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“…10 The greatest risk occurs during correction and is related to stretching or compression of the spinal cord or to compromise of the anterior spinal artery or its feeding vessels resulting in cord ischemia or infarction. [11][12][13] Mechanical injury to the spinal cord or nerve roots can also occur during hardware placement or during passage of hardware through the epidural space.…”

Section: Neurologic Risks Associated With Scoliosis Surgerymentioning

confidence: 99%

“…7,[15][16][17][18][19][20] Intraoperative neurophysiologic monitoring "alerts" prompting surgical reevaluation occur in up to about 9% of cases. 13 The feasibility of spinal cord monitoring using somatosensory evoked potentials (SSEPs) was first demonstrated in 1977. 21 By the early 1980s, SSEP monitoring during scoliosis surgery had become routine at some centers and, based on a retrospective review of over 1,100 consecutive cases with no false negatives, was recognized to be superior to the wake-up test.…”

Section: Intraoperative Monitoring Of Neurologic Functionmentioning

confidence: 99%

Intraoperative Monitoring of Scoliosis Surgery in Young Patients

Manning,

Emerson

2024

Journal of Clinical Neurophysiology

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Summary: Intraoperative neurophysiologic monitoring has added substantially to the safety of spinal deformity surgery correction since its introduction over four decades ago. Monitoring routinely includes both somatosensory evoked potentials and motor evoked potentials. Either modality alone will detect almost all instances of spinal cord injury during deformity correction. The combined use of the two modalities provides complementary information, can permit more rapidly identification of problems, and enhances safety though parallel redundancy should one modality fail. Both techniques are well established and continue to be refined. Although there is room for provider preference, proper monitoring requires attention to technical detail, understanding of the underlying physiology, and familiarity with effects of commonly used anesthetic agents.

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“…After nerve damage occurs, it can be processed in time to avoid nerve root damage caused by intraoperative operations. EMG monitors target muscle EMG activity with real-time and high sensitivity characteristics, and continuous monitoring is feasible 26 . When the thoracic tuberculosis pedicle screw is placed and the lesion is removed, when the traction or screw penetrates the pedicle wall and is close to the nerve root, clamping nerve and accessory structure, the burst waveform can be detected, and the surgeon can check There are operations to adjust.…”

Section: Advantages Of Multi-modal Neuroelectrophysiological Monitoring Used In Spinal Tuberculosis Surgerymentioning

confidence: 99%

Multi‐modal Neuroelectrophysiological Monitoring in the Treatment of Thoracic Tuberculosis with Debridement and Bone Grafting and Posterior Pedicle Screw Fixation via Costal Transverse Process Approach

Zhang

Shi

Xiao

et al. 2021

Orthopaedic Surgery

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Objective: To explore the value of multi-mode neuroelectrophysiological monitoring (MIOM) in evaluating spinal cord and nerve root function in the treatment of thoracic tuberculosis via costal transverse process approach.Methods: From December 2017 to September 2019, a retrospective study of thoracic tuberculosis patients in our hospital was conducted. This study included 25 patients (14 men and 11 women). The average age of patients at the time of surgery was 63.3 years (range, 20-83 years). All patients (three cases with the destruction of a single vertebral body, 13 cases with the destruction of two vertebral bodies, and nine cases with the destruction of three or more vertebral bodies) underwent costal transverse process approach with debridement and bone grafting and internal fixation combined with intraoperative multimodal neuroelectrophysiological monitoring. During the operation, somatosensory evoked potential (SEP), transcranial electrical stimulation motor evoked potential (TES-MEP), and spontaneous electromyography (EMG) were used to monitor progress. ESR, visual analogue scale (VAS), Cobb angle, and Oswestry disability index (ODI) were statistically analyzed to evaluate the treatment effects and patient satisfaction.Results: All 25 patients were successfully monitored. The follow-up time ranged from 12 to 21 months, with an average of 15.3 months. SEP waveform abnormalities occurred in five patients during the operation, the incidence rate was 28%. Of these five patients, three patients changed their instruments and postures, and adjusted the flushing water flow in time; one patient received pressure therapy in time; the operation was suspended for 10 min for one patient. There were seven cases with abnormal TES-MEP waveform, the incidence rate was 28%. Among these seven cases, five cases adjusted the nail path during the operation and adjusted the nail position in time. One case adjusted the inclination angle of the operating table in time; one case completed the contralateral nail stick correction in time; five of them had abnormal TES-MEP waveforms, and EMG burst potential was also detected, the incidence rate was 20%. After prompt treatment, the abnormal waveforms of all patients returned to normal; no abnormal waveforms, recurrence of tuberculosis, loosening of internal fixation, nerve and spinal cord dysfunction, etc. The VAS score, erythrocyte sedimentation rate (ESR), Cobb angle, and ODI scores of the patients 1 year after operation were significantly improved compared with 1 week after operation (P < 0.05). Conclusion:Multi-mode intraoperative electrophysiological detection combined with costal transverse process approach for the treatment of thoracic tuberculosis could avoid intraoperative nerve and blood vessel damage, reduce surgical risk, improve surgical efficiency, and ensure curative effect.

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What Is the Frequency of Intraoperative Alerts During Pediatric Spinal Deformity Surgery Using Current Neuromonitoring Methodology? A Retrospective Study of 218 Surgical Procedures

Abstract: IONM provides data that causes re-evaluation in about 10% of pediatric spinal deformity cases.

Cited by 19 publications

References 24 publications

The influence of anaesthesia on intraoperative neuromonitoring changes in high-risk spinal surgery

The influence of anaesthesia on intraoperative neuromonitoring changes in high-risk spinal surgery

Intraoperative Monitoring of Scoliosis Surgery in Young Patients

Multi‐modal Neuroelectrophysiological Monitoring in the Treatment of Thoracic Tuberculosis with Debridement and Bone Grafting and Posterior Pedicle Screw Fixation via Costal Transverse Process Approach

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