Chun Wai Hung, Fthimnir M Hassan, Nathan J Lee, Steven G Roth, Justin K Scheer, Erik Lewerenz, Joseph M Lombardi, Zeeshan M Sardar, Ronald A Lehman, Lawrence G Lenke
{"title":"脊柱畸形手术中，术中出血量增加与术中3型脊髓形态神经监测数据丢失的风险增加相关。","authors":"Chun Wai Hung, Fthimnir M Hassan, Nathan J Lee, Steven G Roth, Justin K Scheer, Erik Lewerenz, Joseph M Lombardi, Zeeshan M Sardar, Ronald A Lehman, Lawrence G Lenke","doi":"10.1007/s43390-025-01090-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To assess risk factors associated with an increased risk of intraoperative neuromonitoring (IONM) loss among spinal deformity patients with type 3 spinal cord (T3SC) shapes.</p><p><strong>Methods: </strong>This is a retrospective cohort study of adult and pediatric patients with T3SC undergoing spinal deformity surgery from a single center between 2016 and 2023. The primary outcome examined was whether there was IONM data loss. Demographic, clinical, operative, and radiographic variables were compared between patients with and without IONM data loss.</p><p><strong>Results: </strong>A total of 79 patients with T3SC were identified: 31 (39.2%) had IONM data loss, while 48 (60.8%) did not. There were no differences between the groups in terms of age, sex, or BMI (p > 0.05). There were no significant differences in the preoperative and postoperative coronal (C-DAR), sagittal (S-DAR), or total deformity angle ratio (T-DAR) (p > 0.05). There was no difference in the proportion of patients with a VCR, or in the mean instrumented number of levels. There was no difference in measured cord deformation using the area of the spinal cord shape as well as the long- and short-axis dimensions on an axial MRI cut. However, there was a statistically significantly higher EBL (1320.7 ± 614.0 vs. 1049.0 ± 468.4, p = 0.0316), TXA use (2619.8 ± 1333.1 cc vs. 1925.9 ± 1304.2, p = 0.0372), and cell saver salvage (468.5 ± 266.2 vs. 311.5 ± 266.2, p = 0.0264) in the IONM-Loss group.</p><p><strong>Conclusion: </strong>In this largest reported cohort patients with T3SC undergoing spinal deformity surgery, the only factors found to be significantly associated with an increased risk of IONM loss was higher EBL, higher autologous salvage transfused blood volume, and higher TXA given. It is critical for deformity surgeons to be aware of the importance of blood and hemodynamics management when treating this unique and high-risk population.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1573-1583"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Higher intraoperative blood loss is associated with increased risk of intraoperative neuromonitoring data loss for the type 3 spinal cord shape during spinal deformity surgery.\",\"authors\":\"Chun Wai Hung, Fthimnir M Hassan, Nathan J Lee, Steven G Roth, Justin K Scheer, Erik Lewerenz, Joseph M Lombardi, Zeeshan M Sardar, Ronald A Lehman, Lawrence G Lenke\",\"doi\":\"10.1007/s43390-025-01090-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To assess risk factors associated with an increased risk of intraoperative neuromonitoring (IONM) loss among spinal deformity patients with type 3 spinal cord (T3SC) shapes.</p><p><strong>Methods: </strong>This is a retrospective cohort study of adult and pediatric patients with T3SC undergoing spinal deformity surgery from a single center between 2016 and 2023. The primary outcome examined was whether there was IONM data loss. Demographic, clinical, operative, and radiographic variables were compared between patients with and without IONM data loss.</p><p><strong>Results: </strong>A total of 79 patients with T3SC were identified: 31 (39.2%) had IONM data loss, while 48 (60.8%) did not. There were no differences between the groups in terms of age, sex, or BMI (p > 0.05). There were no significant differences in the preoperative and postoperative coronal (C-DAR), sagittal (S-DAR), or total deformity angle ratio (T-DAR) (p > 0.05). There was no difference in the proportion of patients with a VCR, or in the mean instrumented number of levels. There was no difference in measured cord deformation using the area of the spinal cord shape as well as the long- and short-axis dimensions on an axial MRI cut. However, there was a statistically significantly higher EBL (1320.7 ± 614.0 vs. 1049.0 ± 468.4, p = 0.0316), TXA use (2619.8 ± 1333.1 cc vs. 1925.9 ± 1304.2, p = 0.0372), and cell saver salvage (468.5 ± 266.2 vs. 311.5 ± 266.2, p = 0.0264) in the IONM-Loss group.</p><p><strong>Conclusion: </strong>In this largest reported cohort patients with T3SC undergoing spinal deformity surgery, the only factors found to be significantly associated with an increased risk of IONM loss was higher EBL, higher autologous salvage transfused blood volume, and higher TXA given. It is critical for deformity surgeons to be aware of the importance of blood and hemodynamics management when treating this unique and high-risk population.</p>\",\"PeriodicalId\":21796,\"journal\":{\"name\":\"Spine deformity\",\"volume\":\" \",\"pages\":\"1573-1583\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine deformity\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s43390-025-01090-3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine deformity","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s43390-025-01090-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/18 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Higher intraoperative blood loss is associated with increased risk of intraoperative neuromonitoring data loss for the type 3 spinal cord shape during spinal deformity surgery.
Purpose: To assess risk factors associated with an increased risk of intraoperative neuromonitoring (IONM) loss among spinal deformity patients with type 3 spinal cord (T3SC) shapes.
Methods: This is a retrospective cohort study of adult and pediatric patients with T3SC undergoing spinal deformity surgery from a single center between 2016 and 2023. The primary outcome examined was whether there was IONM data loss. Demographic, clinical, operative, and radiographic variables were compared between patients with and without IONM data loss.
Results: A total of 79 patients with T3SC were identified: 31 (39.2%) had IONM data loss, while 48 (60.8%) did not. There were no differences between the groups in terms of age, sex, or BMI (p > 0.05). There were no significant differences in the preoperative and postoperative coronal (C-DAR), sagittal (S-DAR), or total deformity angle ratio (T-DAR) (p > 0.05). There was no difference in the proportion of patients with a VCR, or in the mean instrumented number of levels. There was no difference in measured cord deformation using the area of the spinal cord shape as well as the long- and short-axis dimensions on an axial MRI cut. However, there was a statistically significantly higher EBL (1320.7 ± 614.0 vs. 1049.0 ± 468.4, p = 0.0316), TXA use (2619.8 ± 1333.1 cc vs. 1925.9 ± 1304.2, p = 0.0372), and cell saver salvage (468.5 ± 266.2 vs. 311.5 ± 266.2, p = 0.0264) in the IONM-Loss group.
Conclusion: In this largest reported cohort patients with T3SC undergoing spinal deformity surgery, the only factors found to be significantly associated with an increased risk of IONM loss was higher EBL, higher autologous salvage transfused blood volume, and higher TXA given. It is critical for deformity surgeons to be aware of the importance of blood and hemodynamics management when treating this unique and high-risk population.
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.
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