title: Major intraoperative neurologic monitoring deficits in consecutive pediatric and adult spinal deformity patients at one institution.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  The purpose of this study was to assess the preoperative neurologic risk in a consecutive series of spinal deformity patients undergoing correction surgery at one institution.
  
  
  BACKGROUND
  During spinal deformity correction surgery, neurologic monitoring techniques are commonly applied to reduce the risk of neurologic deficits. While previous studies have demonstrated risk factors for neurologic changes in the setting of spinal surgery, these involved long time spans and heterogeneous patient populations.
  
  
  METHODS
  Of 301 cases performed over 1 year, 281 cases were monitorable. Patients were grouped according to diagnosis: neuromuscular (NM) scoliosis, Sagittal Plane deformity, and Scoliosis. Demographic and surgical data were collected for neurologically monitorable patients. Coronal and sagittal parameters were measured using digital images of radiographs. Neurologic status was measured with somatosensory-evoked potentials and/or motor-evoked potentials.
  
  
  RESULTS
  Primary NM scoliosis cases had the highest incidence of neurologic monitoring changes (NMC) (10%) while revision sagittal plane deformity had the second highest (9.8%). Sensitivity and specificity were both 100%. Overall incidence of neurologic deficit was 1.1%. Of the 13 NMCs patients, 3 patients had persistent neurologic deficit. Majority of NMCs occurred before deformity correction. In patients with NM scoliosis, NMCs increased with hybrid constructs with wires (P < 0.01). In patients with scoliosis, NMCs increased with increased body mass index, estimated blood loss, operative time, and postoperative coronal thoracolumbar curve magnitude (P < 0.04). In patients with primarily sagittal plane deformity, NMCs increased with preoperative proximal curve, postoperative proximal and thoracolumbar curves, and postoperative kyphosis and lordosis (P < 0.04).
  
  
  CONCLUSIONS
  Primary NM scoliosis and revision sagittal plane deformities appear to carry greatest incidence of NMCs during surgical intervention. Most observed NMCs did not result in a permanent neurologic deficit. Neuromonitoring should be assessed throughout the entire surgical procedure. This study may aid surgeons and patients to better assess neurologic risks related to spinal deformity surgery.
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kamerlink
authors.forename: Thomas
authors.initials: T
authors.lastname: Errico
authors.forename: Shaun
authors.initials: S
authors.lastname: Xavier
authors.forename: Ashish
authors.initials: A
authors.lastname: Patel
authors.forename: Amar
authors.initials: A
authors.lastname: Patel
authors.forename: Alexa
authors.initials: A
authors.lastname: Cohen
authors.forename: Mark
authors.initials: M
authors.lastname: Reiger
authors.forename: Joseph
authors.initials: J
authors.lastname: Dryer
authors.forename: David
authors.initials: D
authors.lastname: Feldman
authors.forename: Baron
authors.initials: B
authors.lastname: Lonner
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Beric
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies; D012307:Risk Factors; D013121:Spinal Curvatures / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000601:surgery*