Gupta Munish C, Lenke Lawrence G, Gupta Sachin, Farooqi Ali S, Boachie-Adjei Oheneba, Erickson Mark A, Newton Peter O, Samdani Amer F, Shah Suken A, Shufflebarger Harry L, Sponseller Paul D, Sucato Daniel J, Kelly Michael P
Department of Orthopedic Surgery, Washington University School of Medicine, 660 S. Euclid, Campus, Box 8233, Saint Louis, MO, 63110, USA.
Department of Orthopaedic Surgery, Columbia University Medical Center New York, New York, USA.
Spine Deform. 2024 Jan;12(1):109-118. doi: 10.1007/s43390-023-00745-3. Epub 2023 Aug 9.
To evaluate intraoperative monitoring (IOM) alerts and neurologic deficits during severe pediatric spinal deformity surgery.
Patients with a minimum Cobb angle of 100° in any plane or a scheduled vertebral column resection (VCR) with minimum 2-year follow-up were prospectively evaluated (n = 243). Preoperative, immediate postoperative, and 2-year postoperative neurologic status were reported. Radiographic data included preoperative and 2-year postoperative coronal and sagittal Cobb angles and deformity angular ratios (DAR). IOM alert type and triggering event were recorded. SRS-22r scores were collected preoperatively and 2-years postoperatively.
IOM alerts occurred in 37% of procedures with three-column osteotomy (n = 36) and correction maneuver (n = 32) as most common triggering events. Patients with IOM alerts had greater maximum kyphosis (101.4° vs. 87.5°) and sagittal DAR (16.8 vs. 12.7) (p < 0.01). Multivariate regression demonstrated that sagittal DAR independently predicted IOM alerts (OR 1.05, 95% CI 1.02-1.08) with moderate sensitivity (60.2%) and specificity (64.8%) using a threshold value of 14.3 (p < 0.01). IOM alerts occurred more frequently in procedures with new postoperative neurologic deficits (17/24), and alerts with both SSEP and TCeMEP signals were associated with new postoperative deficits (p < 0.01). Most patients with new deficits experienced resolution at 2 years (16/20) and had equivalent postoperative SRS-22r scores. However, patients with persistent deficits had worse SRS-22r total score (3.8 vs. 4.2), self-image subscore (3.5 vs. 4.1), and function subscore (3.8 vs. 4.3) (p ≤ 0.04).
Multimodal IOM alerts are associated with sagittal kyphosis, and predict postoperative neurologic deficits. Most patients with new deficits experience resolution of their symptoms and have equivalent 2-year outcomes.
II.
评估小儿严重脊柱畸形手术中的术中监测（IOM）警报及神经功能缺损情况。
对任何平面上最小Cobb角为100°或计划进行椎体切除术（VCR）且至少随访2年的患者进行前瞻性评估（n = 243）。报告术前、术后即刻及术后2年的神经功能状态。影像学数据包括术前及术后2年的冠状面和矢状面Cobb角以及畸形角比（DAR）。记录IOM警报类型及触发事件。收集术前及术后2年的SRS - 22r评分。
在三柱截骨术（n = 36）和矫正操作（n = 32）作为最常见触发事件的手术中，37%出现了IOM警报。出现IOM警报的患者最大后凸角更大（101.4°对87.5°），矢状面DAR更高（16.8对12.7）（p < 0.01）。多因素回归分析表明，矢状面DAR独立预测IOM警报（OR 1.05，95% CI 1.02 - 1.08），使用阈值14.3时具有中等敏感性（60.2%）和特异性（64.8%）（p < 0.01）。IOM警报在术后出现新神经功能缺损的手术中更频繁发生（17/24），同时出现SSEP和TCeMEP信号的警报与术后新缺损相关（p < 0.01）。大多数有新缺损的患者在2年时症状缓解（16/20），且术后SRS - 22r评分相当。然而，有持续性缺损的患者SRS - 22r总分（3.8对4.2）、自我形象子评分（3.5对4.1）和功能子评分（3.8对4.3）更差（p≤0.04）。
多模式IOM警报与矢状面后凸相关，并可预测术后神经功能缺损。大多数有新缺损的患者症状会缓解，且2年预后相当。
II级。
