Garg Bhavuk, Mohapatra Subrat, Mehta Nishank
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
All India Institute of Medical Sciences, New Delhi, India.
Spine Deform. 2020 Dec;8(6):1369-1374. doi: 10.1007/s43390-020-00163-9. Epub 2020 Jun 24.
To investigate whether intraoperative neuromonitoring (IONM) may be avoided in growing rod lengthening procedures in early onset scoliosis (EOS).
A total of 636 primary growing rod surgeries and lengthening procedures were performed in 112 patients with EOS. Traditional growing rods (TGR) or magnetically controlled growing rods (MCGR) were implanted and subsequent lengthening procedures were done at stipulated intervals. Combined multi-modality IONM was used in all index surgeries-but was only used in lengthening procedures in patients with existing spinal cord abnormality or a history of neurosurgical procedure for the same, patients with prior history of a neuromonitoring alert in their index surgery and when lengthening was accompanied by an implant exchange/revision. All the remaining growing rod lengthening procedures were carried out without IONM. Hospital records and operation notes were retrospectively reviewed with focus on details of neurological events/complications.
In 112 primary growing rod applications (TGR = 96, MCGR = 16) and 524 lengthening procedures (TGR = 444, MCGR = 80), intraoperative neuromonitoring 'alerts' were encountered in 6/112 index surgeries and temporary postoperative neurological deficits were seen in 2/112 index surgeries. No intraoperative neuromonitoring event or postoperative neurological complication was encountered in 524 lengthening procedures-irrespective of whether they were carried out along with implant exchange, or in patients with spinal cord abnormality or prior neuromonitoring event during index surgery.
While IONM should be used in primary growing rod application surgeries, its use may be avoided in lengthening and implant exchange procedures in a resource-limited setting.
Level 3.
探讨在早发性脊柱侧弯（EOS）的生长棒延长手术中是否可以避免术中神经监测（IONM）。
对112例EOS患者进行了636例初次生长棒手术和延长手术。植入传统生长棒（TGR）或磁控生长棒（MCGR），并按规定间隔进行后续延长手术。所有初次手术均使用联合多模式IONM，但仅在存在脊髓异常或有相同神经外科手术史的患者、初次手术中有神经监测警报史的患者以及延长手术伴有植入物更换/翻修时才在延长手术中使用。其余所有生长棒延长手术均在无IONM的情况下进行。回顾性查阅医院记录和手术记录，重点关注神经事件/并发症的细节。
在112例初次生长棒应用（TGR = 96，MCGR = 16）和524例延长手术（TGR = 444，MCGR = 80）中，6/112例初次手术中出现术中神经监测“警报”，2/112例初次手术中出现术后短暂神经功能缺损。在524例延长手术中未遇到术中神经监测事件或术后神经并发症，无论这些手术是否与植入物更换同时进行，也无论患者是否存在脊髓异常或初次手术时有神经监测事件。
虽然在初次生长棒应用手术中应使用IONM，但在资源有限的情况下，延长手术和植入物更换手术中可避免使用IONM。
3级。
