Journal Basic Info
- Impact Factor: 1.995**
- H-Index: 8
- ISSN: 2474-1647
- DOI: 10.25107/2474-1647
- Obstetrics Surgery
- Oral and Maxillofacial Surgery
- General Surgery
- Endocrine Surgery
- Minimally Invasive Surgery
- Neurological Surgery
- Surgical Oncology
- Pediatric Surgery
Citation: Clin Surg. 2019;4(1):2455.Research Article | Open Access
Intraoperative Neuromonitoring in Pediatric Spinal Deformity Surgery: Risk Factors Analysis about 1048 Cases
Paris Descartes University, France
Department of Neurophysiology, GHU Paris Psychiatry Neurosciences, France
INSERM UMR 1266, France
CNRS UMR 7287, ISM, Marseille, France
Department of Pediatric Orthopedics, Timone Hospital, Marseille, France
Spine research laboratory, Hospital for Special Surgery, New York, USA
Aix Marseille University, France
Department of Neurophysiology, Timone Hospital, Marseille, France
Background: In spinal deformity surgery, one of the primary goals is to avoid surgically induced neurological deficits. Neurophysiological Intraoperative Monitoring (NIOM) has been proposed as an effective means of decreasing permanent neurologic injury. Material and
Methods: In this retrospective study, a total of 1064 consecutive pediatric spinal procedures between 2004 and 2016, at a single institution, were reviewed (745 females, mean age: 12.6 years). There were 821 (77%) primary and 243 (23%) revision surgeries. NIOM included as possible the combination of somato-sensory evoked potentials with descending neurogenic evoked potentials, D-waves and motor evoked potentials.
Results: Sixteen patients were characterized by unreliable baseline data. Review of NIOM was thus performed in 1048 cases. These cases corresponded to 558 (53%) idiopathic and 490 (47%) nonidiopathic spine deviations. The overall incidence of significant alerts was 6% and overall permanent neurological deficit was 0.7%. There were six major neurological deficits. Two cases of delayed cord-level deficit occurred. NIOM revealed 975 true negatives (93.2%), 65 true positives (6%), 4 false positives (0.4%) and 4 false negatives (0.4%). The sensitivity of IOM was thus 94% while its specificity was 99%. Four etiologies were significantly associated with a higher rate of intraoperative and postoperative complications: post-thoracotomy scoliosis (p<0.001*), achondroplasia and other bone dystrophies (p<0.001*), neurofibromatosis type1 (p=0.045*) and mucopolysaccharidosis (p=0.005*).
Conclusion: Early NIOM detection affords the surgical team an opportunity to reverse impeding neurological sequelae. This large series of pediatric spinal deformity surgery demonstrated significantly higher rates of intra and postoperative complications in four etiologies. This has been already described in NF1, mucopolysaccharidosis and achondroplasia related spine deformities but not in post-thoracotomy scoliosis.
Scoliosis; Kyphosis; Neurofibromatosis type 1; Post-thoracotomy scoliosis
Cite the article
Gavaret M, Pesenti S, Pennaroli D, Diop-Sene MS, Choufani E, Varghese JJ, et al. Intraoperative Neuromonitoring in Pediatric Spinal Deformity Surgery: Risk Factors Analysis about 1048 Cases. Clin Surg. 2019; 4: 2455.