Abstract
Objective: To determine the utility of widely used intraoperative neuromonitoring (IONM) alert criteria and intervention for predicting postoperative outcome following paediatric spinal surgery.
Methods: Retrospective analysis of somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) in consecutive cervical spine fixations. An intervention protocol followed amplitude-reductions in SSEPs (≥50 %) and/or MEPs (≥80 %). Alert breaches were reversed when SSEP/MEP amplitude was restored to > 50 %/20 % of baseline. Sensorimotor function was assessed preoperatively and 3-months postoperatively via the Modified McCormick Scale score (MMS). We explored associations between postoperative outcome, demographic/surgical and IONM variables.
Results: Forty-five procedures in 38 children (mean age:9 ± 4 years;55 % female) were monitored, 42 %of which breached alert criteria. Instrumentation (6/19,32 %) and hypotension (5/19,26 %) were common causes for alert and the majority (13/19,68 %) were reversed following intervention. There was an association between pre- and post-MMS and the type of breach (p = 0.002). All children with worse postoperative MMS (3/38,8%) had irreversible breaches.
Conclusions: IONM in this small sample accurately detected neurological injury. The majority of breaches reversed following an intervention protocol. Irreversible breaches frequently led to worse postoperative sensorimotor function.
Significance: An intervention protocol which reversed IONM alerts never resulted in postoperative worsening of sensorimotor function.
Methods: Retrospective analysis of somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) in consecutive cervical spine fixations. An intervention protocol followed amplitude-reductions in SSEPs (≥50 %) and/or MEPs (≥80 %). Alert breaches were reversed when SSEP/MEP amplitude was restored to > 50 %/20 % of baseline. Sensorimotor function was assessed preoperatively and 3-months postoperatively via the Modified McCormick Scale score (MMS). We explored associations between postoperative outcome, demographic/surgical and IONM variables.
Results: Forty-five procedures in 38 children (mean age:9 ± 4 years;55 % female) were monitored, 42 %of which breached alert criteria. Instrumentation (6/19,32 %) and hypotension (5/19,26 %) were common causes for alert and the majority (13/19,68 %) were reversed following intervention. There was an association between pre- and post-MMS and the type of breach (p = 0.002). All children with worse postoperative MMS (3/38,8%) had irreversible breaches.
Conclusions: IONM in this small sample accurately detected neurological injury. The majority of breaches reversed following an intervention protocol. Irreversible breaches frequently led to worse postoperative sensorimotor function.
Significance: An intervention protocol which reversed IONM alerts never resulted in postoperative worsening of sensorimotor function.
| Original language | English |
|---|---|
| Pages (from-to) | 239-244 |
| Number of pages | 6 |
| Journal | Clinical Neurophysiology Practice |
| Volume | 7 |
| DOIs | |
| Publication status | Published - 28 Jul 2022 |
Bibliographical note
Funding Information:We wish to thank Birmingham Health Partners for their support, and all the clinicians involved in the care of these children; particularly those from the departments of neurophysiology, neurosurgery and theatres, and anaesthesia at Birmingham Children's Hospital.
Publisher Copyright:
© 2022
Keywords
- Electrophysiology
- Intraoperative neuromonitoring
- Motor evoked potential
- Neurosurgery
- Pediatric spinal surgery
- Somatosensory evoked potential
ASJC Scopus subject areas
- Clinical Neurology
- Neurology
- Physiology (medical)