False negative intraoperative neuromonitoring alerts during pediatric spinal deformity surgery: the dreaded outcome.

IF 1.8 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2025-08-11 DOI:10.1007/s43390-025-01154-4

Hilton C Braithwaite Iv, Chris Bozorgmehr, Leah Rakers, Scott J Luhmann

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引用次数: 0

Abstract

Introduction: Intraoperative neuromonitoring (IONM) reduces postoperative spinal cord dysfunction during pediatric spinal deformity surgery by allowing intraoperative corrective actions. Currently, data on false negative IONM events in this population are limited. The purpose of this study is to describe false negative IONM cases and explore immediate and final outcomes.

Methods: An institutional neuromonitoring database (November 1992-April 2024) was reviewed to identify patients (0-18 years) who underwent spinal deformity surgery and experienced false negative IONM. The modalities included somatosensory evoked potentials (SSEP), descending neurogenic evoked potentials (DNEP), and transcranial motor-evoked potentials (TcMEP).

Results: Out of the 5317 consecutive cases, 16 patients (0.32%) experienced false negative outcomes. Mean age was 14 years (11-16). Five cases (31.3%) had abnormal neurologic status preoperatively, and all 16 patients experienced neurologic decline, postoperatively. Outcomes were stratified by injury level: among spinal cord-level cases with known outcomes (n = 7), 29% achieved complete recovery; 90% of spinal cord-level injuries used SSEP/DNEP and 10% used SSEP/TcMEP. In nerve root-level cases (n = 6), 17% achieved full recovery. Reoperations included three decompressions, two instrumentation removals, and two revisions. At final follow-up, three patients (19%) had complete recovery, five (31%) partial recovery, five (31%) no recovery, and outcomes were unknown in three (19%).

Conclusion: This is the largest series of false negative IONM cases in pediatric spinal deformity surgery to date, with 16 false negative outcomes (0.32%) from 5317 consecutive pediatric spinal deformity cases. In worst case scenario only 19% made a complete recovery. Currently, TcMEP and SSEP monitoring is standard of care and when both are used there was only one false negative case, supporting their use over SSEP/DNEP to mitigate the risk of false negative IONM in spinal cord level surgeries.

查看原文本刊更多论文

小儿脊柱畸形手术中假阴性神经监测警报：可怕的结果。

导言：术中神经监测（IONM）通过允许术中纠正措施减少小儿脊柱畸形手术后脊髓功能障碍。目前，该人群中IONM假阴性事件的数据有限。本研究的目的是描述假阴性的IONM病例，并探讨即时和最终的结果。方法：回顾机构神经监测数据库（1992年11月至2024年4月），以确定0-18岁的脊柱畸形手术患者，并出现假阴性IONM。模式包括体感诱发电位（SSEP）、下行神经源性诱发电位（DNEP）和经颅运动诱发电位（TcMEP）。结果：在5317例连续病例中，16例（0.32%）出现假阴性结局。平均年龄14岁（11-16岁）。5例（31.3%）患者术前神经功能异常，16例患者术后神经功能减退。结果按损伤程度分层：在已知结果的脊髓水平病例中（n = 7）， 29%完全恢复；脊髓水平损伤90%采用SSEP/DNEP， 10%采用SSEP/TcMEP。在神经根水平的病例（n = 6）中，17%完全恢复。再手术包括3次减压、2次器械移除和2次修复。在最后随访时，3例（19%）患者完全恢复，5例（31%）部分恢复，5例（31%）未恢复，3例（19%）患者预后未知。结论：这是迄今为止小儿脊柱畸形手术中最大的IONM假阴性病例系列，在5317例连续的小儿脊柱畸形病例中有16例假阴性结果（0.32%）。在最坏的情况下，只有19%的人完全恢复了。目前，TcMEP和SSEP监测是标准的护理，当两者同时使用时，只有1例假阴性病例，支持使用它们而不是SSEP/DNEP来降低脊髓水平手术中假阴性IONM的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.