The Efficacy of Motor Evoked Potentials in Fixed Sagittal Imbalance Deformity Correction Surgery

Object Intraoperative monitoring of the spinal cord has become the standard of care during surgery for pediatric spinal deformity correction. The use of both somatosensory and motor evoked potentials has dramatically increased the sensitivity and specificity of detecting intraoperative neurophysiological changes to the spinal cord, which assists in the intraoperative decision-making process. The authors report on a large, single-center experience with neuromonitoring changes and outline the surgical management of patients who experience significant neuromonitoring changes during spinal deformity correction surgery. Methods The authors conducted a retrospective review of all cases involving pediatric patients who underwent spinal deformity correction surgery at Shriners Hospital for Children, Philadelphia, between January 2007 and March 2010. Five hundred nineteen consecutive cases were reviewed in which neuromonitoring was used, with 47 cases being identified as having significant changes in somatosensory evoked potentials, motor evoked potentials, or both. These cases were reviewed for patient demographic data and surgical characteristics. Results The incidence of significant neuromonitoring changes was 9.1% (47 of 519 cases), including 6 cases of abnormal Stagnara wake-up tests, of which 4 had corroborated postoperative neurological deficits (8.5% of 47 cases, 0.8% of 519). In response to neuromonitoring changes, wake-up tests were performed in 37 (79%) of 47 cases, hardware was adjusted in 15 (32%), anesthesiology interventions were reported in 5 (11%), hardware was removed in 5 (11%), the patient was successfully repositioned in 3 (6%), and the procedure was aborted in 13 (28%). In 1 of the 4 patients with new postoperative deficits, the deficit had fully resolved by the last follow-up; the other 3 patients had persistent neurological impairment as of the most recent follow-up examination. The authors observed a sensitivity of 100% for intraoperative neuromonitoring. Conclusions Due to the profound risks associated with spinal deformity surgery, intraoperative neurophysiological monitoring is an integral tool to warn of impending spinal cord injury. Intraoperative neuromonitoring appears to provide a safe and useful warning mechanism to minimize spinal cord injury that may arise during scoliosis correction surgery in pediatric patients.

Download Full-text

Somatosensory and motor evoked potentials during correction surgery of scoliosis in neurologically asymptomatic Chiari malformation-associated scoliosis: A comparison with idiopathic scoliosis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.105689 ◽

2020 ◽

Vol 191 ◽

pp. 105689 ◽

Cited By ~ 1

Author(s):

Bo Shi ◽

Junyin Qiu ◽

Liang Xu ◽

Yang Li ◽

Dengxu Jiang ◽

...

Keyword(s):

Idiopathic Scoliosis ◽

Evoked Potentials ◽

Chiari Malformation ◽

Motor Evoked Potentials ◽

Correction Surgery

Download Full-text

Transvertebral Transposition of the Spinal Cord for Recovery of Motor Evoked Potentials and Somatosensory Evoked Potentials After Acute Paraplegia During Kyphoscoliosis Surgery: Technique Note, Case Reports and Literature Review

10.21203/rs.3.rs-129833/v1 ◽

2020 ◽

Author(s):

Chao Chen ◽

Jing Li ◽

Bingjin Wang ◽

Lingwei Zhu ◽

Yong Gao ◽

...

Keyword(s):

Spinal Cord ◽

Evoked Potentials ◽

Somatosensory Evoked Potentials ◽

Motor Evoked Potentials ◽

Case Reports ◽

Deformity Correction ◽

Neurological Deficits ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Acute Paraplegia

Abstract Background: Neurological impairment during spinal deformity surgery was the most serious complication. When confronting intraoperative neurophysiological monitoring alerts, various surgical management methods such as the release of implants and decompression of the spinal cord are always performed. Transvertebral transposition of the spinal cord is rarely performed, and its role in the management of acute paraplegia is seldom reported.Methods: The authors present two patients with kyphoscoliosis experienced intraoperatively or postoperatively neurological deficits and abnormal neurological monitoring was detected during correction surgery. Acute paraplegia was confirmed by a wake-up test. Subsequent spinal cord transposition was performed. Intraoperative neurophysiological monitoring motor evoked potentials (MEP) and somatosensory evoked potentials (SEP) was performed to detect the changes during the process.Results: After transvertebral transposition of the spinal cord, the MEPs and SEPs were significantly improved in both patients during surgery. The spinal cord function was restored postoperatively and recovered to normal at the final follow-up in two patients. Conclusions： This case demonstrated that instead of decreasing the correction ratio of kyphoscoliosis, transvertebral transposition of the spinal cord under intraoperative neurophysiological monitoring could be an effective therapeutic strategy for acute spinal cord dysfunction caused by deformity correction surgeries.

Download Full-text

Neuromonitoring During Surgery for Paediatric Spinal Deformity in Canada (2007)

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100006302 ◽

2009 ◽

Vol 36 (1) ◽

pp. 47-50 ◽

Cited By ~ 4

Author(s):

Jonathan Norton ◽

Douglas Hedden

Keyword(s):

Spinal Deformity ◽

Motor Evoked Potentials ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Standard Of Care ◽

National Standards ◽

Spinal Deformity Surgery ◽

Correction Surgery ◽

Training Programmes ◽

Spinal Cord Function

Background:Neuromonitoring during paediatric (and adult) spinal deformity surgery helps to reduce the risk of both permanent and short term neurological damage. A shortage of neurophysiologists and technicians limits the availability of this service. Not all surgeons believe neuromonitoring offers neuroprotection during spinal surgery. This study aimed to document the degree to which paediatric patients undergoing spinal deformity correction surgery have their spinal cord function monitored.Methods:A questionnaire was sent electronically to all of the surgical members of the Canadian Paediatric Spinal Deformity Study Group.Results:Results were received from 9/9 centres indicating that monitoring was performed in 7/9 centres, with one further centre awaiting staffing. Whilst half of those centres that do monitor only monitor sensory and motor evoked potentials, the remaining centres also use EMG and EEG to assess the state of the patient intraoperatively.Conclusions:Despite a shortage of staff, most paediatric spinal deformity surgeons in Canada who wish to, are able to neurophysiologically monitor their surgical cases. Neuromonitoring appears to be becoming a standard of care, at least for paediatric spinal deformity surgery. There is an urgent need for the establishment of national standards for both technologists and interpreters, as well as training programmes for both these groups.

Download Full-text

Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: a meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2017.3.spine161134 ◽

2017 ◽

Vol 27 (5) ◽

pp. 540-551 ◽

Cited By ~ 6

Author(s):

Chang-Hyun Lee ◽

Chun Kee Chung ◽

Jee-Soo Jang ◽

Sung-Min Kim ◽

Dong-Kyu Chin ◽

...

Keyword(s):

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Meta Analysis ◽

Deformity Correction ◽

Vertical Axis ◽

Sagittal Imbalance ◽

Kyphosis Angle ◽

Sagittal Vertical Axis ◽

Correction Surgery ◽

The Mean

OBJECTIVEAs life expectancy continues to increase, primary degenerative sagittal imbalance (PDSI) is diagnosed in an increasing number of elderly people. Although corrective surgery for this sagittal deformity is becoming more popular, the effectiveness of the procedure remains unclear. The authors aimed to collate the available evidence on the effectiveness and complications of deformity-correction surgery in patients with PDSI.METHODSThe authors carried out a meta-analysis of clinical studies regarding deformity correction in patients with PDSI. The studies were identified through searches of the PubMed, Embase, Web of Science, and Cochrane databases. Surgery outcomes were evaluated and overall treatment effectiveness was assessed in terms of the minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) values and pain levels according to visual analog scale (VAS) scores and in terms of restoration of spinopelvic parameters to within a normal range. Data are expressed as mean differences with 95% CIs.RESULTSTen studies comprising 327 patients were included. The VAS and ODI values improved after deformity-correction surgery. The smallest treatment effect exceeded the MCID for VAS values (4.15 [95% CI 3.48–4.82]) but not for ODI values (18.11 [95% CI 10.99–25.23]). At the final follow-up visit, the mean lumbar lordosis angle (−38.60° [95% CI −44.19° to −33.01°]), thoracic kyphosis angle (31.10° [95% CI 24.67°–37.53°]), C-7 sagittal vertical axis (65.00 mm [95% CI 35.27–94.72 mm]), and pelvic tilt angle (30.82° [95% CI 24.41°–37.23°]) remained outside their normal ranges. Meta-regression analyses revealed a significant effect of ODI change in relation to lumbar lordosis change (p = 0.004). After a mean of 2 years after deformity correction, the mean lumbar lordosis angle and C-7 sagittal vertical axis decreased by 5.82° and 38.91 mm, respectively, and the mean thoracic kyphosis angle increased by 4.7°. The incidences of proximal junctional kyphosis and pseudarthrosis were 23.7% and 12.8%, respectively.CONCLUSIONSDeformity correction substantially relieves back pain for about 2 years in adult patients with PDSI. Sufficient surgical restoration of lumbar lordosis can lead to substantial improvement in patient disability and reduced decompensation. Deformity correction represents a viable therapeutic option for patients with PDSI, but further technical advancements are necessary to achieve sufficient lumbar lordosis and reduce complication rates.

Download Full-text