Al-Naseem Abdulrahman O, Al-Naseem Abdulaziz O, Cawley Derek T, Aoude Ahmed, Catanzano Anthony A, Abd-El-Barr Muhammad M, Sharma Aman, Shafafy Roozbeh
Division of Surgery & Interventional Science, University College London, London, UK.
Department of Spinal Surgery, Royal National Orthopaedic Hospital NHS Foundation Trust, Stanmore, UK.
Global Spine J. 2024 Sep;14(7):2170-2182. doi: 10.1177/21925682241237475. Epub 2024 Mar 1.
Systematic literature review and meta-analysis.
Predicting patient risk of intraoperative neuromonitoring (IONM) alerts preoperatively can aid patient counselling and surgical planning. Sielatycki et al established an axial-MRI-based spinal cord classification system to predict risk of IONM alerts in scoliosis correction surgery. We aim to systematically review the literature on operative and radiologic factors associated with IONM alerts, including a novel spinal cord classification.
A systematic review and meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A literature search identifying all observational studies comparing patients with and without IONM alerts was conducted. Suitable studies were included. Patient demographics, radiological measures and operative factors were collected.
11 studies were included including 3040 patients. Relative to type 3 cords, type 1 (OR = .03, CI = .01-.08, < .00001), type 2 (OR = .08, CI = .03, <.00001) and all non-type 3 cords (OR = .05, CI = .02-.16, < .00001) were associated with significantly lower odds of IONM alerts. Significant radiographic measures for IONM alerts included coronal Cobb angle (MD = 10.66, CI = 5.77-15.56, < .00001), sagittal Cobb angle (MD = 9.27, CI = 3.28-14.73, = .0009), sagittal deformity angle ratio (SDAR) (MD = 2.76, CI = 1.57-3.96, < .00001) and total deformity angle ratio (TDAR) (MD = 3.44, CI = 2.27-4.462, < .00001). Clinically, estimated blood loss (MD = 274.13, CI = -240.03-788.28, = .30), operation duration (MD = 50.79, CI = 20.58-81.00, = .0010), number of levels fused (MD = .92, CI = .43-1.41, = .0002) and number of vertebral levels resected (MD = .43, CI = .01-.84, = .05) were significantly greater in IONM alert patients.
This study highlights the relationship of operative and radiologic factors with IONM alerts.
系统文献综述与荟萃分析。
术前预测患者术中神经监测（IONM）警报风险有助于患者咨询和手术规划。Sielatycki等人建立了一种基于轴向MRI的脊髓分类系统，以预测脊柱侧弯矫正手术中IONM警报的风险。我们旨在系统回顾与IONM警报相关的手术和放射学因素的文献，包括一种新的脊髓分类。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统回顾和荟萃分析。进行文献检索，以识别所有比较有和没有IONM警报患者的观察性研究。纳入合适的研究。收集患者人口统计学、放射学测量和手术因素。
纳入11项研究，共3040例患者。相对于3型脊髓，1型（OR = 0.03，CI = 0.01 - 0.08，P < 0.00001）、2型（OR = 0.08，CI = 0.03，P < 0.00001）和所有非3型脊髓（OR = 0.05，CI = 0.02 - 0.16，P < 0.00001）与IONM警报的显著较低几率相关。IONM警报的显著放射学测量指标包括冠状位Cobb角（MD = 10.66，CI = 5.77 - 15.56，P < 0.00001）、矢状位Cobb角（MD = 9.27，CI = 3.28 - 14.73，P = 0.0009）、矢状位畸形角比（SDAR）（MD = 2.76，CI = 1.57 - 3.96，P < 0.00001）和总畸形角比（TDAR）（MD = 3.44，CI = 2.27 - 4.462，P < 0.00001）。临床上，IONM警报患者的估计失血量（MD = 274.13，CI = -240.03 - 788.28，P = 0.30）、手术持续时间（MD = 50.79，CI = 20.58 - 81.00，P = 0.0010）、融合节段数（MD = 0.92，CI = 0.43 - 1.41，P = 0.0002）和切除椎体节段数（MD = 0.43，CI = 0.01 - 0.84，P = 0.05）显著更多。
本研究突出了手术和放射学因素与IONM警报的关系。
