Intraoperative neurophysiological monitoring changes during surgical correction of pediatric neuromuscular scoliosis: a single-institution report.

Abstract

Purpose: Intraoperative neurophysiological monitoring (IONM) is a tool that can improve safety during spinal surgery. Patients with neuromuscular scoliosis (NMS) have inherent neural axis or primary muscle pathology that may present challenges to neuromonitoring. An understanding of IONM event rates, patterns, and outcomes would better prepare surgeons to counsel patients and families.

Methods: IONM data from pediatric spine deformity correction procedures in patients with neuromuscular scoliosis at a single quaternary care center between 2012 and 2022 were reviewed to determine cases with monitorable IONM data as well as cases with IONM events. Surgical data and radiographic measures were compared between cases with and without lower extremity IONM events.

Results: 443 surgical cases were reviewed with 404 (91.2%) monitorable. Of monitorable cases, 37 (9.2%) cases had an IONM event. There were 363 (82.0%) cases were monitorable from the lower extremities, and of these, there were 27 (7.4%) cases had IONM events. One case (1/363 = 0.3%) had clinically identifiable post-surgical neurological complications. Statistical comparisons revealed more blood loss (p = 0.0473) and a trend toward more severe deformity angular ratio (p = 0.07) in cases with lower extremity intraoperative IONM events than those without.

Conclusion: This study provides an estimate of IONM events and clinically identifiable neurological injury for children with neuromuscular scoliosis. These rates were similar to those reported in studies of other populations of children with spine deformity which supports the feasibility of IONM. Our data suggest that lower extremity IONM events tend to happen in more severe spine deformity cases.