Dermal Discolorations and Burns at Neuromonitoring Electrodes in Pediatric Spine Surgery.
METHODS
Prospective review of consecutive patients.


OBJECTIVE
To evaluate the incidence and raise awareness of electrode discoloration that can occur in the operating room when using neuromonitoring.


BACKGROUND
To our knowledge there are no articles that discuss dermal discolorations following spine surgery.


METHODS
Following recognition of dermal discolorations in some patients, a prospective evaluation of all patients undergoing spine surgery with somatosensory-evoked potential and motor-evoked potential neuromonitoring using subdermal needle electrodes was carried out over a 16-month period for quality assurance and improvement.


RESULTS
A total of 201 consecutive patients with mean age of 14 years (4-25) were prospectively evaluated. Sixteen percent (33/201) had dermal discolorations associated with neuromonitoring. There were no significant differences in mean age (P = 0.624), height (P = 0.308), weight (P = 0.899), or body mass index (P = 0.571) between the patients with and without dermal discolorations. There was also no difference in prevalence of dermal discoloration by diagnosis (P = 0.490) or location of grounding pad and occurrence of dermal discoloration between groups (P = 0.268). The only difference noted was that patients without dermal discoloration had an average monopolar cautery setting of 46.8 W compared to 40.5 W for patients with dermal discolorations (P = 0.042). Of the 33 patients with a dermal discoloration, 27% (9/33) of these were on both the upper and lower extremities, 21% (7/33) on only the upper extremities, and 52% (17/33) on only the lower extremities. None of the dermal discolorations were painful or tender, and all resolved by 6-month follow-up. One patient did not have any dermal discoloration but did experience two full-thickness burns around the electrodes in one leg. The incidence of burns in this series was 0.5% (1/201).


CONCLUSIONS
Dermal discolorations occurred in 16% of patients undergoing neuromonitoring for spine surgery. These common discolorations were painless and resolved by 6 months. More significant burns were uncommon, occurring in less than 1%.


METHODS
3.
Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Austin
A
Sanders
Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Lindsay
L
Andras
Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Alison
A
Lehman
Department of Perioperative Services, Children's Hospital Los Angeles, Los Angeles, CA.
Nancy
N
Bridges
Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
David L
DL
Skaggs
D000293:Adolescent; D000328:Adult; D002056:Burns / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000009:adverse effects*; D013131:Spine / Q000601:surgery*; D055815:Young Adult