title: Spinal Cord Monitoring Data in Pediatric Spinal Deformity Patients With Spinal Cord Pathology.
abstract: METHODS
  Retrospective.
  
  
  OBJECTIVE
  The purpose of this study is to review the efficacy of monitoring data and outcomes in pediatric patients with spinal cord pathology.
  
  
  BACKGROUND
  The incidence of spinal cord pathology in pediatric patients with scoliosis has been reported between 3% and 20%. Previous studies demonstrated that intraoperative spinal cord monitoring (IOM) during scoliosis surgery can be reliable despite underlying pathology.
  
  
  METHODS
  A single-center retrospective review of 119 spinal surgery procedures in 82 patients with spinal cord pathology was performed. Diagnoses included Arnold-Chiari malformation, syringomyelia, myelomeningocele, spinal cord tumor, tethered cord, and diastematomyelia. Baseline neurologic function and history of prior neurosurgical intervention were identified. Outcome measures included ability to obtain reliable monitoring data during surgery and presence of postoperative neurologic deficits. Results were compared for 82 patients with adolescent idiopathic scoliosis (AIS).
  
  
  RESULTS
  Usable IOM data were obtained in 82% of cases (97/119). Twenty-two cases (18%) had no lower extremity data. Patients with Arnold-Chiari malformation or syringomyelia pathologies, in isolation or together, had a significantly higher rate of reliable data compared to other pathologies (p < .0001). Among study group cases with usable data, there were 1 false negative (1%) and 4 true positive (4%) outcomes. There were no permanent neurologic deficits. The spinal cord pathology group demonstrated 80% sensitivity and 92% specificity.
  
  
  CONCLUSIONS
  Spinal cord monitoring is a valuable tool in pediatric patients with spinal cord pathology undergoing spinal deformity surgeries. When obtained, data allow to detect changes in spinal cord function. Patients with a diagnosis of Arnold-Chiari or syringomyelia have monitoring data similar to those patients with AIS. Patients with other spinal cord pathologies have less reliable data, and surgeons should have a lower threshold for performing wake-up tests to assess spinal cord function intraoperatively.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Aleem
authors.affiliation: Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
authors.forename: Earl D
authors.initials: ED
authors.lastname: Thuet
authors.affiliation: Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Padberg
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Wallendorf
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; St. Louis Children's Hospital, St. Louis, MO 63110, USA; St. Louis Shriners Hospital, St. Louis, MO 63110, USA. Electronic address: LuhmannS@wustl.edu.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Luhmann
keywords: Neuromuscular scoliosis; Pediatric deformity; Scoliosis; Spinal cord monitoring; Spinal cord pathology