在垂直可扩张钛肋骨植入术（VEPTR）过程中未出现术中神经监测（IONM）警报的患者在随后的常规扩张过程中未发生神经系统损伤：一项回顾性多中心队列研究。

Patients Without Intraoperative Neuromonitoring (IONM) Alerts During VEPTR Implantation Did Not Sustain Neurological Injury During Subsequent Routine Expansions: A Retrospective Multicenter Cohort Study.

作者信息

LaGreca Jaren, Flynn Tara, Cahill Patrick J, Samdani Amer, Vitale Michael G, El-Hawary Ron, Smith John T, Phillips Jonathan H, Flynn John M, Glotzbecker Michael, Garg Sumeet

机构信息

*University of Colorado School of Medicine, Aurora, CO †Children's Spine Foundation, Valley Forge ‡The Children's Hospital of Philadelphia §Shriners Hospital for Children in Philadelphia, Philadelphia, PA ∥Morgan Stanley Children's Hospital New York-Presbyterian, New York, NY ¶IWK Health Centre, Halifax, Nova Scotia, Canada #Primary Children's Medical Center, Salt Lake City, UT **Orlando Health, Orlando, FL ††Children's Hospital Boston, Boston, MA ‡‡Children's Hospital Colorado, Orthopedics Institute, University of Colorado, Aurora, CO.

出版信息

J Pediatr Orthop. 2017 Dec;37(8):e619-e624. doi: 10.1097/BPO.0000000000000976.

DOI:10.1097/BPO.0000000000000976

PMID:28328563

Abstract

BACKGROUND

The purpose of this study was to determine the rate of intraoperative neurological monitoring (IONM) alerts and neurological injury during vertical expandable prosthetic titanium rib (VEPTR) treatment and evaluate the utility of IONM during VEPTR expansion procedures in patients who have not previously had neurological injury or IONM alerts.

METHODS

After institutional review board approval, VEPTR procedures and IONM records were reviewed at 17 institutions for patients treated with VEPTR from 2005 to 2011. All consecutive cases in patients with minimum 2-year follow-up were included. Patients with prior history of growing rods or other invasive spine-based surgical treatment were excluded. Surgeries were categorized into implant, revision, expansion, and removal procedures. Cases with IONM alerts or neurological injury had additional detailed review. Descriptive statistics were used for data analysis.

RESULTS

In total, 2355 consecutive VEPTR procedures (352 patients) consisting of 299 implant, 377 revision, 1587 expansion, and 92 removal procedures were included. In total, 620 VEPTR procedures had IONM, and 539 of those had IONM records available for review. IONM alerts occurred in 9/539 procedures (1.7%): 3/192 implants (1.6%), 3/58 revisions (5.2%), and 3/258 expansions (1.2%). New neurological injury occurred in 3/2355 procedures (0.1%), 3/352 patients (0.9%). All 3 injuries were in implant procedures, only 1 had an IONM alert. All 3 had upper extremity motor deficits (1 had sensory deficit also). All had full recovery at 17, 30, and 124 days postinjury. One patient without prior neurological injury or IONM alert had an IONM alert during expansion that resolved after an increase in blood pressure. The remaining IONM alerts during expansions were all in children with prior IONM alerts during implant, revision, or exchange procedures.

CONCLUSIONS

The highest rate of neurological injury in VEPTR surgery was found for implant procedures. There were no instances of neurological injury during VEPTR expansion, revision, or removal procedures. IONM did not identify new neurological injuries in patients undergoing VEPTR expansion who did not previously have a history of IONM signal change or neurologic injury.

LEVEL OF EVIDENCE

Level IV-diagnostic study.

摘要

背景

本研究的目的是确定垂直可扩张人工钛肋骨（VEPTR）治疗期间术中神经监测（IONM）警报率和神经损伤情况，并评估IONM在既往无神经损伤或IONM警报的患者进行VEPTR扩张手术中的作用。

方法

经机构审查委员会批准后，对17家机构2005年至2011年接受VEPTR治疗的患者的VEPTR手术及IONM记录进行回顾。纳入所有至少随访2年的连续病例。排除既往有生长棒或其他基于脊柱的侵入性手术治疗史的患者。手术分为植入、翻修、扩张和取出手术。对有IONM警报或神经损伤的病例进行了额外的详细回顾。采用描述性统计进行数据分析。

结果

共纳入2355例连续的VEPTR手术（352例患者），包括299例植入手术、377例翻修手术、1587例扩张手术和92例取出手术。总共有620例VEPTR手术进行了IONM监测，其中539例有可供回顾的IONM记录。IONM警报发生在9/539例手术中（1.7%）：3/192例植入手术（1.6%）、3/58例翻修手术（5.2%）和3/258例扩张手术（1.2%）。新的神经损伤发生在3/2355例手术中（0.1%），3/352例患者中（0.9%）。所有3例损伤均发生在植入手术中，只有1例有IONM警报。所有3例均有上肢运动功能障碍（1例也有感觉功能障碍）。所有患者在受伤后17天、30天和124天均完全恢复。1例既往无神经损伤或IONM警报的患者在扩张过程中出现IONM警报，血压升高后警报解除。扩张过程中其余的IONM警报均发生在植入、翻修或置换手术中有过IONM警报的儿童患者中。