Ni Jiajun, Guo Xinhu, Sun Zhuoran, Zhao Chunwei, Chen Zhongqiang, Zeng Yan
Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China.
Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.
J Orthop Surg Res. 2025 Mar 24;20(1):305. doi: 10.1186/s13018-025-05693-4.
Intraoperative neuromonitoring (IONM) alerts are critical concerns for surgeons performing spinal deformity corrective surgeries, as they indicate a heighteded risk of postoperative neurological deficits. Previous studies have demonstrated that patients with large Cobb angle or elevated deformity angular ratio (DAR) are at an increased risk of IONM alerts. However, spinal curves with similar Cobb angles and DARs may exhibit significantly different risks of IONM alerts during surgery. Current methods for evaluating spinal deformity fail to comprehensively and accurately reflect its severity. The purpose of this study was to investigate whether the deformity angular distance ratio (DADR) serves as an independent predictor of IONM alerts during corrective surgery for spinal deformity.
This study analyzed a consecutive series of 404 patients undergoing corrective surgery at a single academic center. Preoperative radiographs were used to calculate the DAR and DADR. Twelve clinically relevant candidate variables were selected for univariable analysis. Multivariable logistic regression analysis was then conducted to identify independent predictors of IONM alerts.
The incidence of IONM alerts in this cohort was 25.2%. Univariable analysis identified several factors potentially associated with IONM alerts, including older age, type-III spinal cord morphology, location of apex, etiological diagnosis, preoperative sagittal Cobb angle, sagittal DAR, sagittal DADR, coronal DADR, total DAR, total DADR, three-column osteotomy, and preoperative neurological deficits. Multivariable analysis revealed that an apex location at C7-T4, preoperative neurological deficits, sagittal DADR, and total DADR were independent predictors of IONM alerts.
Among patients undergoing corrective surgeries for spinal deformities, the DADR is a robust measure of spinal deformity severity and is strongly correlated with the risk of IONM alerts. Compared to other deformity parameters, DADR is an independent predictor of IONM alerts. Additional independent predictors include the location of the apex and the presence of preoperative neurological deficits.
术中神经监测（IONM）警报是脊柱畸形矫正手术外科医生极为关注的问题，因为它们提示术后神经功能缺损风险增加。既往研究表明，Cobb角大或畸形角比（DAR）升高的患者发生IONM警报的风险增加。然而，Cobb角和DAR相似的脊柱侧弯在手术期间发生IONM警报的风险可能存在显著差异。目前评估脊柱畸形的方法未能全面、准确地反映其严重程度。本研究的目的是探讨畸形角距离比（DADR）是否可作为脊柱畸形矫正手术期间IONM警报的独立预测指标。
本研究分析了在单一学术中心接受矫正手术的404例连续患者。术前X线片用于计算DAR和DADR。选择12个临床相关的候选变量进行单变量分析。然后进行多变量逻辑回归分析以确定IONM警报的独立预测指标。
该队列中IONM警报的发生率为25.2%。单变量分析确定了几个可能与IONM警报相关的因素，包括年龄较大、III型脊髓形态、顶椎位置、病因诊断、术前矢状面Cobb角、矢状面DAR、矢状面DADR、冠状面DADR、总DAR、总DADR、三柱截骨术和术前神经功能缺损。多变量分析显示，C7 - T4节段的顶椎位置、术前神经功能缺损、矢状面DADR和总DADR是IONM警报的独立预测指标。
在接受脊柱畸形矫正手术的患者中，DADR是衡量脊柱畸形严重程度的可靠指标，且与IONM警报风险密切相关。与其他畸形参数相比，DADR是IONM警报的独立预测指标。其他独立预测指标包括顶椎位置和术前神经功能缺损的存在。
