Responding to Intraoperative Neuromonitoring Changes During Pediatric Coronal Spinal Deformity Surgery
| العنوان: | Responding to Intraoperative Neuromonitoring Changes During Pediatric Coronal Spinal Deformity Surgery |
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| المؤلفون: | Ahmet Alanay, Lawrence G. Lenke, Sigurd Berven, Laura Holmes, Christopher J. Nielsen, Manabu Ito, Yong Qiu, Marinus de Kleuver, Ian Vreugdenhil, Ian H Y Wong, David W. Polly, Kenneth M.C. Cheung, Christopher I. Shaffrey, Reinhard Zeller, Hailey Bensky, Stephen Lewis, Samuel Strantzas, David E Lebel, Niccole Germscheid |
| المصدر: | Global Spine Journal, 9, 1 Suppl, pp. 15s-21s Global Spine Journal Global Spine Journal, 9, 15s-21s |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | medicine.medical_specialty, Brown-Séquard syndrome, Anemia, Scoliosis, AOSpine Knowledge Forum Deformity, perfusion, Brown-Sequard syndrome, anterior cord syndrome, medicine, Orthopedics and Sports Medicine, Spinal cord injury, transfusion, scoliosis, business.industry, medicine.disease, anemia, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], pediatric, incomplete spinal cord injuries, Coronal plane, Spinal deformity, Anterior cord syndrome, Neurology (clinical), motor evoked potentials, business, neuromonitoring |
| الوصف: | Study Design: Retrospective case study on prospectively collected data. Objectives: The purpose of this explorative study was: 1) to determine if patterns of spinal cord injury could be detected through intra-operative neuromonitoring (IONM) changes in pediatric patients undergoing spinal deformity corrections, 2) to identify if perfusion based or direct trauma causes of IONM changes could be distinguished, 3) to observe the effects of the interventions performed in response to these events, and 4) to attempt to identify different treatment algorithms for the different causes of IONM alerts. Methods: Prospectively collected neuromonitoring data in pre-established forms on consecutive pediatric patients undergoing coronal spinal deformity surgery at a single center was reviewed. Real-time data was collected on IONM alerts with >50% loss in signal. Patients with alerts were divided into 2 groups: unilateral changes (direct cord trauma), and bilateral MEP changes (cord perfusion deficits). Results: A total of 97 pediatric patients involving 71 females and 26 males with a mean age of 14.9 (11-18) years were included in this study. There were 39 alerts in 27 patients (27.8% overall incidence). All bilateral changes responded to a combination of transfusion, increasing blood pressure, and rod removal. Unilateral changes as a result of direct trauma, mainly during laminotomies for osteotomies, improved with removal of the causative agent. Following corrective actions in response to the alerts, all cases were completed as planned. Signal returned to near baseline in 20/27 patients at closure, with no new neurological deficits in this series. Conclusion: A high incidence of alerts occurred in this series of cases. Dividing IONM changes into perfusion-based vs direct trauma directed treatment to the offending cause, allowing for safe corrections of the deformities. Patients did not need to recover IONM signal to baseline to have a normal neurological examination. |
| وصف الملف: | application/pdf |
| تدمد: | 2192-5682 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b408e149b5d2ecea5f62734867b4dad6 https://doi.org/10.1177/2192568219836993 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....b408e149b5d2ecea5f62734867b4dad6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 21925682 |
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