title: Efficacy of Intraoperative Neurophysiologic Monitoring for Pediatric Cervical Spine Surgery.
abstract: METHODS
  Clinical case series.
  
  
  OBJECTIVE
  To investigate the efficacy of intraoperative neuromonitoring in pediatric cervical spine surgery.
  
  
  BACKGROUND
  Intraoperative neuromonitoring (IONM) consisting of somatosensory-evoked potentials (SSEP) and transcranial motor-evoked potentials (tcMEP) has been shown to effectively prevent permaneny neurologic injury in deformity surgery. The role of IONM during pediatric cervical spine surgery is not well documented. Advances in cervical spine instrumentation have expanded the surgical options in pediatric populations. The goal of this study is to report the ability of IONM to detect neurologic injury during pediatric cervical spine instrumentation.
  
  
  METHODS
  A single institution database was queried for pediatric-aged patients who underwent cervical spine instrumentation and fusion between 2011 and 2014. Age, diagnosis, surgical indication, number of instrumented levels, and a complete IONM were extracted. Sensitivity and specificity for the detection of neurologic deficits were calculated with exact 95% confidence intervals. Positive and negative predictive values were calculated with estimated 95% confidence intervals.
  
  
  RESULTS
  Sixty-seven patients who underwent cervical spine instrumentation were identified with a mean age of 11.6 years (range 1-18). Diagnoses included instability (27), congenital (11), kyphosis (8), fracture (7), tumor (7), arthritis (4), and basilar invagination (3). Mean number of vertebral levels fused was 4 (range 2-7). All patients underwent cervical instrumentation with SSEP and tcMEP monitoring. A significant change in tcMEP monitoring was observed in 7 subjects (10%). There were no corresponding SSEP changes in these patients. The sensitivity of combined IONM was 75% [95% CI = 24.9, 98.7] and the specificity was 98.5% [92.7, 99.9].
  
  
  CONCLUSIONS
  tcMEP is a more sensitive indicator to spinal cord injury than SSEP, which is consistent with previous studies. IONM changes in 10% of a patient population are significant enough to warrant intraoperative determination if true SCI has occurred or is underway and intervene accordingly.
  
  
  METHODS
  4.
authors: Harvard Combined Orthopaedic Residency Program, Boston, MA.|Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
authors: Daniel G
authors: DG
authors: Tobert
authors: Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
authors: Michael P
authors: MP
authors: Glotzbecker
authors: Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
authors: Michael Timothy
authors: MT
authors: Hresko
authors: Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
authors: Lawrence I
authors: LI
authors: Karlin
authors: Department of Neurological Surgery, Children's Hospital Boston, Boston, MA.
authors: Mark R
authors: MR
authors: Proctor
authors: Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
authors: John B
authors: JB
authors: Emans
authors: Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
authors: Patricia E
authors: PE
authors: Miller
authors: Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
authors: Daniel J
authors: DJ
authors: Hedequist
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods* / Q000592:standards; D008297:Male; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000601:surgery*; D013122:Spinal Diseases / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome