The Recognition, Incidence, and Management of Spinal Cord Monitoring Alerts in Early-onset Scoliosis Surgery.
BACKGROUND
The objective of the research was to study the relevance of intraoperative neuromonitoring throughout all stages of surgical management in patients with progressive early-onset scoliosis (EOS).The routine monitoring of spinal cord potentials has gradually become standard of practice among spinal surgeons. However, there is not a consensus that the added expense of this technique necessitates monitoring in all stages of surgical management.


METHODS
A retrospective review of 180 surgical cases of 30 patients with EOS from July 2003 to July 2012 was performed. All monitoring alerts as judged by the neuromonitoring team were identified. Both somatosensory-evoked potentials and transcranial electric motor-evoked potentials were studied and no limiting thresholds for reporting electrophysiological changes were deemed appropriate.


RESULTS
Of 150 monitored cases there were 18 (12%) monitoring alerts. This represented 40% of the patient cohort over the 9-year study period.


CONCLUSIONS
Index versus routine lengthening rate of alerts showed no significant difference in incidence of monitoring alerts. Conversely, several patients whose primary implantation surgeries were uneventful had monitoring alerts later in their treatment course. Intraoperative neuromonitoring is warranted throughout all stages of surgical management of EOS.


METHODS
Level IV. This study is a retrospective review of surgical cases of 30 patients with EOS.
*Department of Pediatric Orthopedics, Arnold Palmer Hospital ‡Intraoperative Neuromonitoring, Orlando Health, Orlando †University of Florida JAX, Jacksonville, FL.
Jonathan H
JH
Phillips
Robert C
RC
Palmer
Denise
D
Lopez
Dennis R
DR
Knapp
Jose
J
Herrera-Soto
Michael
M
Isley
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000209:etiology; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000209:etiology