title: Comparison of multimodal intraoperative neurophysiological monitoring efficacy in early childhood and school aged children undergoing spinal surgery.
abstract: OBJECTIVE
  The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age.
  
  
  METHODS
  43 children, diagnosed with spinal pathologies were divided into two cohorts according to their age and enrolled in the study. Those under the age of 6 consisted group A, whereas those between the age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according to their diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded and evaluated at specific time points for each patient.
  
  
  RESULTS
  Except for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There was no false-negative whereas 9 false positive recordings due to physiological conditions that all recovered intraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosis component. The tcMEPs fully recovered by the end of the operation except for the patient with post-tuberculosis kyphosis. There was no statistically significant difference in the mean threshold values with regard to transcranial stimulus intensity for the tcMEPs between the two groups.
  
  
  CONCLUSIONS
  Compared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM is effective for early childhood patients undergoing spinal surgery.
  
  
  METHODS
  Level III, Diagnostic Study.
authors.affiliation: Gazi University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey. Electronic address: drsenkoylu@gmail.com.
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Şenköylü
authors.affiliation: Gazi University, Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Zinnuroğlu
authors.affiliation: Gazi University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey.
authors.forename: Alp
authors.initials: A
authors.lastname: Börçek
authors.affiliation: Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Department of Orthopaedics and Traumatology, Ankara, Turkey.
authors.forename: Erdem
authors.initials: E
authors.lastname: Aktaş
authors.affiliation: Gazi University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey.
authors.forename: İrfan
authors.initials: İ
authors.lastname: Güngör
authors.affiliation: Gazi University, Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Beyazova
mesh_terms: D002648:Child; D002675:Child, Preschool; D004576:Electromyography / Q000379:methods; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods; D064795:Intraoperative Neurophysiological Monitoring / Q000295:instrumentation / Q000379:methods; D019637:Orthopedic Procedures / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D013122:Spinal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014421:Turkey
keywords: Children; Intraoperative monitoring; Motor evoked potentials; Somatosensory evoked potentials; Spine surgery