title: What Is the Frequency of Intraoperative Alerts During Pediatric Spinal Deformity Surgery Using Current Neuromonitoring Methodology? A Retrospective Study of 218 Surgical Procedures.
abstract: BACKGROUND
  There is variability in intraoperative neuromonitoring (IONM), anesthetic and surgical techniques for the treatment of pediatric spinal deformity. This study evaluates a series of patients treated at multiple centers utilizing transcranial motor and somatosensory evoked potentials (TcMEP and SSEP) and electromyography (EMG). The frequency of alerts and the intraoperative follow-up is reported.
  
  
  METHODS
  Standard patient demographics and IONM data were collected from a two-month cohort of pediatric spine deformity cases.
  
  
  RESULTS
  Data from 218 scoliosis patients were included from 46 facilities and 72 surgeons. Baseline upper and lower extremity TcMEP data were present in 96.7% and 93.9% patients respectively. Baseline upper and lower SSEPs were present in 99.5% and 95.4% respectively Surgical TCMEP alerts occurred in 19 (8.7%) patients during deformity correction (n = 11), placement of instrumentation (n = 5), decompression (n = 2), and closing (n = 1) with concurrent SSEP alerts occurring in five patients. Nine had TCMEP recovery, eight showed partial recovery and two did not recover. Additional alerts occurred due to: positioning (n = 16), inhalational agent change (n = 4), global physiological change (n = 4) and technical reasons (n = 2). A total of 2164 pedicle screws were tested. Of 197 (9.1%) screws that tested from 6-9 mA, 171 (65.4%) were left unchanged, 10 (51%) removed, eight (4.1%) repositioned with improved threshold, and eight (4.1%) without improvement. Of 26 screws that tested ≤ 5 milliamperes (mA), 17 (65.4%) were left unchanged, five (19.2%) removed, two (7.7%) repositioned with improved threshold, and two (7.7%) without improvement.
  
  
  CONCLUSIONS
  IONM provides data that causes re-evaluation in about 10% of pediatric spinal deformity cases.
authors.forename: David W
authors.initials: DW
authors.lastname: Polly
authors.forename: Kent
authors.initials: K
authors.lastname: Rice
authors.forename: Arvydas
authors.initials: A
authors.lastname: Tamkus
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D056902:Clinical Alarms; D015331:Cohort Studies; D004569:Electroencephalography; D004576:Electromyography; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007223:Infant; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D065289:Pedicle Screws; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013131:Spine / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome