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Major Intraoperative Neurologic Monitoring Deficits in Consecutive Pediatric and Adult Spinal Deformity Patients at One Institution

Kamerlink, Jonathan R. MD*; Errico, Thomas MD*; Xavier, Shaun MD*; Patel, Ashish MD*; Patel, Amar BA*; Cohen, Alexa*; Reiger, Mark MD*; Dryer, Joseph MD*; Feldman, David MD*; Lonner, Baron MD*; Beric, Aleksandar MD; Schwab, Frank MD*

doi: 10.1097/BRS.0b013e3181c7c8f6

Study Design. Retrospective review.

Objective. The purpose of this study was to assess the preoperative neurologic risk in a consecutive series of spinal deformity patients undergoing correction surgery at one institution.

Summary of Background Data. During spinal deformity correction surgery, neurologic monitoring techniques are commonly applied to reduce the risk of neurologic deficits. While previous studies have demonstrated risk factors for neurologic changes in the setting of spinal surgery, these involved long time spans and heterogeneous patient populations.

Methods. Of 301 cases performed over 1 year, 281 cases were monitorable. Patients were grouped according to diagnosis: neuromuscular (NM) scoliosis, Sagittal Plane deformity, and Scoliosis. Demographic and surgical data were collected for neurologically monitorable patients. Coronal and sagittal parameters were measured using digital images of radiographs. Neurologic status was measured with somatosensory-evoked potentials and/or motor-evoked potentials.

Results. Primary NM scoliosis cases had the highest incidence of neurologic monitoring changes (NMC) (10%) while revision sagittal plane deformity had the second highest (9.8%). Sensitivity and specificity were both 100%. Overall incidence of neurologic deficit was 1.1%. Of the 13 NMCs patients, 3 patients had persistent neurologic deficit. Majority of NMCs occurred before deformity correction. In patients with NM scoliosis, NMCs increased with hybrid constructs with wires (P < 0.01). In patients with scoliosis, NMCs increased with increased body mass index, estimated blood loss, operative time, and postoperative coronal thoracolumbar curve magnitude (P < 0.04). In patients with primarily sagittal plane deformity, NMCs increased with preoperative proximal curve, postoperative proximal and thoracolumbar curves, and postoperative kyphosis and lordosis (P < 0.04).

Conclusion. Primary NM scoliosis and revision sagittal plane deformities appear to carry greatest incidence of NMCs during surgical intervention. Most observed NMCs did not result in a permanent neurologic deficit. Neuromonitoring should be assessed throughout the entire surgical procedure. This study may aid surgeons and patients to better assess neurologic risks related to spinal deformity surgery.

The purpose of this study was to assess the preoperative neurologic risk in a consecutive series of spinal deformity patients undergoing correction surgery at one institution. The results of this study demonstrated that sensitivity and specificity were both 100% while overall incidence of neurologic deficits was 1.1%.

From the Departments of *Orthopaedic Surgery, and †Neurology, NYU Hospital for Joint Diseases, New York, NY.

Acknowledgment date: June 12, 2009. First revision date: September 7, 2009. Second revision date: October 2, 2009. Acceptance date: October 5, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Frank Schwab, MD, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 303 Second Ave, Suite 19, New York, NY 10003; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.