The role of intraoperative neurophysiological monitoring in pediatric patients during surgical treatment of idiopathic scoliosis
DOI:
https://doi.org/10.15574/PS.2025.4(89).4753Keywords:
idiopathic scoliosis, spinal deformity, spinal surgery safety, posterior corrective spinal instrumentation, intraoperative neurophysiological monitoring, motor evoked potentialsAbstract
Iatrogenic spinal cord injury leading to paraplegia is a rare but severe complication. Its prevalence during correction of spinal deformities, according to estimates by the Scoliosis Research Society to be at least 1%. Intraoperative neurophysiological monitoring (IONM) is widely used for real-time feedback on spinal cord function to alert the surgical team about potentially reversible neurological deficits, allowing early detection of intraoperative spinal cord injury, which enables early intervention, leading to a better prognosis.
Aim - to determine the significance of the sensitivity and specificity of motor evoked potentials for predicting and preventing neurological deficits during surgical treatment of idiopathic scoliosis in children.
Materials and methods. The study included 90 patients diagnosed with idiopathic scoliosis of the thoracolumbar spine. We analyzed the following modalities of intraoperative neurophysiological monitoring (IONM) - free run electromyography and motor evoked potentials (MEP), with measurement of the amplitude of the motor response. When the MЕP amplitude decreased by more than 70% from the baseline, or completely disappeared on one or both sides, all patients underwent measures according to the MЕP loss protocol, which was modified by us.
Results. Changes in motor evoked potential were observed in 22 (24.4%) cases. Postoperative transient neurological deficit was observed in 10 (11%) patients, which regressed within 2-3 weeks after surgery. In our calculations, MEP method sensitivity was 100%, specificity was 85%, positive predictive value was 45.5%, and negative predictive value was 100%.
Conclusions. Intraoperative neurophysiological monitoring using MEP is effective for predicting and preventing threatening neurological deficits during surgical treatment of idiopathic scoliosis in children. MEP monitoring has high sensitivity and specificity for detecting new spinal cord injuries in pediatric patients undergoing surgery for idiopathic scoliosis. Application of measures according to the MEP signal loss protocol is effective in reducing the number of patients with postoperative iatrogenic neurological deficit who have changes in MEP indicators during the intraoperative period.
The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the institution. Informed consent was obtained from patients for the study.
The authors declare no conflict of interest.
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