title: Can Intraoperative Spinal Cord Monitoring Reliably Help Prevent Paraplegia During Posterior Vertebral Column Resection Surgery?
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  Analyze patients who underwent posterior vertebral column resection (PVCR) above the conus medullaris with intraoperative spinal cord monitoring (SCM) data loss.
  
  
  BACKGROUND
  PVCR is a powerful technique for treating severe spinal deformity but carries a high risk for major spinal cord deficits.
  
  
  METHODS
  We assessed clinical, radiographic, and electrophysiologic monitoring and operative records of 90 consecutive adult and pediatric patients (mean age, 24.8 years; range, 7.5-76.8) who underwent PVCR above the conus medullaris for severe spinal deformity performed from 2002 to 2010 by one surgeon at one institution.
  
  
  RESULTS
  Fifteen of 90 patients (16.7%) (10 male/5 female; mean age, 15 years) lost SCM (n = 13) or had data degradation meeting warning criteria (n = 2). Diagnoses were kyphoscoliosis (n = 8), angular kyphosis (n = 3), global kyphosis (n = 2), and severe scoliosis (n = 2). Seven were revisions. The average pre-/postoperative scolioses were 99° (range, 32°-152°) and 43° (range, 6°-76°), respectively. The average pre-/postoperative kyphoses were +100° (range, 60°-170°) and +54° (range, 28°-100°), respectively. SCM fluctuated during osteotomy on nine occasions, stabilizing with elevation of blood pressure in addition to anterior spinal cord decompression in four, correction of subluxation in one, and traction reduction in one. Seven patients had SCM changes during rod compression. Three required partial release of correction, two larger cage insertion, one subluxation correction, and one pedicle screw removal. One experienced changes during rod placement/removal, and another, as a result of hypothermia. Data returned in all after prompt intervention (mean, 10.1 minutes; range, 1-60) and all awoke with intact lower extremity function.
  
  
  CONCLUSIONS
  The prevalence of SCM changes during PVCR above the conus medullaris was 16.7%, mostly during osteotomy and rod/screw compression. Data returned with prompt intervention and all had intact lower extremity motor function postoperatively. These SCM "saves" strongly emphasize the importance of multimodality neurophysiologic monitoring during high-risk cases, minimizing postoperative complications.
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029, USA.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
authors.affiliation: Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA. Electronic address: lenkel@wudosis.wustl.edu.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.affiliation: Barnes-Jewish Hospital, 1 Barnes Jewish Hospital Plaza, St. Louis, MO 63110, USA.
authors.forename: Shelly M
authors.initials: SM
authors.lastname: Bolon
authors.affiliation: Albert Einstein Medical Center, 5501 Old York Road, Ste 1, Philadelphia, PA 19141, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Pahys
authors.affiliation: Albert Einstein Medical Center, 5501 Old York Road, Ste 1, Philadelphia, PA 19141, USA.
authors.forename: Woojin
authors.initials: W
authors.lastname: Cho
authors.affiliation: Regions Hospital, 640 Jackson St, St. Paul, MN 55101, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Kang
authors.affiliation: Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA.
authors.forename: Lukas P
authors.initials: LP
authors.lastname: Zebala
authors.affiliation: Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Koester
keywords: Paraplegia; Spinal cord monitoring; Spinal deformity; Vertebral column resection