Lee Nathan J, Lenke Lawrence G, Yeary Mitchell, Dionne Alexandra, Nnake Chidebelum, Fields Michael, Simhon Matthew, Shi Ted, Arvind Varun, Ferraro Anastasia, Cooney Matthew, Lewerenz Erik, Reyes Justin L, Roth Steven, Hung Chun Wai, Scheer Justin K, Zervos Thomas, Thuet Earl D, Lombardi Joseph M, Sardar Zeeshan M, Lehman Ronald A, Hassan Fthimnir M
Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
The Och Spine Hospital, New York-Presbyterian, New York, NY, USA.
Spine Deform. 2025 Jan;13(1):261-272. doi: 10.1007/s43390-024-00944-6. Epub 2024 Aug 8.
To determine if an improvement in cord-level intraoperative neuromonitoring (IONM) data following data loss results in a reduced risk for new postoperative motor deficit in pediatric and adult spinal deformity surgery.
A consecutive series of 1106 patients underwent spine surgery from 2015 to 2023 by a single surgeon. Cord alerts were defined by Somatosensory-Evoked Potentials (SSEP; warning criteria: 10% increase in latency or > 50% loss in amplitude) and Motor-Evoked Potentials (MEP; warning criteria: 75% loss in amplitude without return to acceptable limits after stimulation up 100 V above baseline level). Timing of IONM loss and recovery, interventions, and baseline/postoperative day 1 (POD1) lower extremity motor scores were analyzed.
IONM Cord loss was noted in 4.8% (53/11,06) of patients and 34% (18/53) with cord alerts had a POD1 deficit compared to preoperative motor exam. MEP and SSEP loss attributed to 98.1% (52/53) and 39.6% (21/53) of cord alerts, respectively. Abnormal descending neurogenic-evoked potential (DNEP) was seen in 85.7% (12/14) and detected 91.7% (11/12) with POD1 deficit. Abnormal wake-up test (WUT) was seen in 38.5% (5/13) and detected 100% (5/5) with POD1 deficit. Most cord alerts occurred during a three-column osteotomy (N = 23/53, 43%); decompression (N = 12), compression (N = 7), exposure (N = 4), and rod placement (N = 14). Interventions were performed in all 53 patients with cord loss and included removing rods/less correction (N = 11), increasing mean arterial pressure alone (N = 10), and further decompression with three-column osteotomy (N = 9). After intervention, IONM data improved in 45(84.9%) patients (Full improvement: N = 28; Partial improvement: 17). For those with full and partial IONM improvement, the POD1 deficit was 10.7% (3/28) and 41.2% (7/17), respectively. For those without any IONM improvement (15.1%, 8/53), 100% (8/8) had a POD1 deficit, P < 0.001.
A full or partial improvement in IONM data loss after intraoperative intervention was significantly associated with a lower risk for POD1 deficit with an absolute risk reduction of 89.3% and 58.8%, respectively. All patients without IONM improvement had a POD1 neurologic deficit.
确定小儿及成人脊柱畸形手术中数据丢失后脊髓水平术中神经监测（IONM）数据的改善是否会降低术后新发运动功能障碍的风险。
2015年至2023年，由一名外科医生连续为1106例患者实施脊柱手术。脊髓警报由体感诱发电位（SSEP；警告标准：潜伏期增加10%或波幅降低>50%）和运动诱发电位（MEP；警告标准：波幅降低75%，在高于基线水平100V刺激后未恢复到可接受限度）定义。分析IONM数据丢失和恢复的时间、干预措施以及基线/术后第1天（POD1）下肢运动评分。
4.8%（53/1106）的患者出现IONM脊髓数据丢失，与术前运动检查相比，34%（18/53）出现脊髓警报的患者在POD1时有运动功能障碍。MEP和SSEP数据丢失分别占脊髓警报的98.1%（52/53）和39.6%（21/53）。85.7%（12/14）的患者出现异常下行神经源性诱发电位（DNEP），91.7%（11/12）的POD1运动功能障碍患者检测到该异常。38.5%（5/13）的患者出现异常唤醒试验（WUT），100%（5/5）POD1运动功能障碍患者检测到该异常。大多数脊髓警报发生在三柱截骨术期间（N = 23/53，43%）；减压（N = 12）、压迫（N = 7）、暴露（N = 4）和棒置入（N = 14）。对所有53例脊髓数据丢失的患者进行了干预，包括取出棒/减少矫正（N = 11）、单纯提高平均动脉压（N = 10）以及通过三柱截骨术进一步减压（N = 9）。干预后，45例（84.9%）患者的IONM数据得到改善（完全改善：N = 28；部分改善：17）。对于IONM完全改善和部分改善的患者，POD1运动功能障碍发生率分别为10.7%（3/28）和41.2%（7/17）。对于IONM未改善的患者（15.1%，8/53），100%（8/8）有POD1运动功能障碍，P < 0.001。
术中干预后IONM数据丢失完全或部分改善与POD1运动功能障碍风险降低显著相关，绝对风险分别降低89.3%和58.8%。所有IONM未改善的患者均有POD1神经功能障碍。
