Phillips Jonathan H, Palmer Robert C, Lopez Denise, Knapp Dennis R, Herrera-Soto Jose, Isley Michael
*Department of Pediatric Orthopedics, Arnold Palmer Hospital ‡Intraoperative Neuromonitoring, Orlando Health, Orlando †University of Florida JAX, Jacksonville, FL.
J Pediatr Orthop. 2017 Dec;37(8):e581-e587. doi: 10.1097/BPO.0000000000000795.
The objective of the research was to study the relevance of intraoperative neuromonitoring throughout all stages of surgical management in patients with progressive early-onset scoliosis (EOS).The routine monitoring of spinal cord potentials has gradually become standard of practice among spinal surgeons. However, there is not a consensus that the added expense of this technique necessitates monitoring in all stages of surgical management.
A retrospective review of 180 surgical cases of 30 patients with EOS from July 2003 to July 2012 was performed. All monitoring alerts as judged by the neuromonitoring team were identified. Both somatosensory-evoked potentials and transcranial electric motor-evoked potentials were studied and no limiting thresholds for reporting electrophysiological changes were deemed appropriate.
Of 150 monitored cases there were 18 (12%) monitoring alerts. This represented 40% of the patient cohort over the 9-year study period.
Index versus routine lengthening rate of alerts showed no significant difference in incidence of monitoring alerts. Conversely, several patients whose primary implantation surgeries were uneventful had monitoring alerts later in their treatment course. Intraoperative neuromonitoring is warranted throughout all stages of surgical management of EOS.
Level IV. This study is a retrospective review of surgical cases of 30 patients with EOS.
本研究的目的是探讨术中神经监测在早发性进行性脊柱侧弯（EOS）患者手术治疗各阶段中的相关性。脊髓电位的常规监测已逐渐成为脊柱外科医生的标准操作。然而，对于这项技术增加的费用是否有必要在手术治疗的所有阶段进行监测，目前尚无共识。
对2003年7月至2012年7月期间30例EOS患者的180例手术病例进行回顾性研究。确定神经监测团队判断的所有监测警报。对体感诱发电位和经颅电刺激运动诱发电位均进行了研究，且未认为有合适的报告电生理变化的限制阈值。
在150例监测病例中，有18例（12%）出现监测警报。在9年的研究期间，这占患者队列的40%。
索引与常规警报延长率显示监测警报发生率无显著差异。相反，一些初次植入手术顺利的患者在治疗过程后期出现了监测警报。EOS手术治疗的所有阶段都有必要进行术中神经监测。
IV级。本研究是对30例EOS患者手术病例的回顾性研究。
