Hung Chun Wai, Hassan Fthimnir M, Lee Nathan J, Roth Steven G, Scheer Justin K, Lewerenz Erik, Lombardi Joseph M, Sardar Zeeshan M, Lehman Ronald A, Lenke Lawrence G
Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Spine Deform. 2025 Apr 18. doi: 10.1007/s43390-025-01090-3.
To assess risk factors associated with an increased risk of intraoperative neuromonitoring (IONM) loss among spinal deformity patients with type 3 spinal cord (T3SC) shapes.
This is a retrospective cohort study of adult and pediatric patients with T3SC undergoing spinal deformity surgery from a single center between 2016 and 2023. The primary outcome examined was whether there was IONM data loss. Demographic, clinical, operative, and radiographic variables were compared between patients with and without IONM data loss.
A total of 79 patients with T3SC were identified: 31 (39.2%) had IONM data loss, while 48 (60.8%) did not. There were no differences between the groups in terms of age, sex, or BMI (p > 0.05). There were no significant differences in the preoperative and postoperative coronal (C-DAR), sagittal (S-DAR), or total deformity angle ratio (T-DAR) (p > 0.05). There was no difference in the proportion of patients with a VCR, or in the mean instrumented number of levels. There was no difference in measured cord deformation using the area of the spinal cord shape as well as the long- and short-axis dimensions on an axial MRI cut. However, there was a statistically significantly higher EBL (1320.7 ± 614.0 vs. 1049.0 ± 468.4, p = 0.0316), TXA use (2619.8 ± 1333.1 cc vs. 1925.9 ± 1304.2, p = 0.0372), and cell saver salvage (468.5 ± 266.2 vs. 311.5 ± 266.2, p = 0.0264) in the IONM-Loss group.
In this largest reported cohort patients with T3SC undergoing spinal deformity surgery, the only factors found to be significantly associated with an increased risk of IONM loss was higher EBL, higher autologous salvage transfused blood volume, and higher TXA given. It is critical for deformity surgeons to be aware of the importance of blood and hemodynamics management when treating this unique and high-risk population.
评估3型脊髓（T3SC）形态的脊柱畸形患者术中神经监测（IONM）信号丢失风险增加的相关危险因素。
这是一项对2016年至2023年间在单一中心接受脊柱畸形手术的成年和儿科T3SC患者的回顾性队列研究。检查的主要结局是是否存在IONM数据丢失。对有和没有IONM数据丢失的患者的人口统计学、临床、手术和影像学变量进行了比较。
共确定了79例T3SC患者：31例（39.2%）出现IONM数据丢失，而48例（60.8%）未出现。两组在年龄、性别或BMI方面无差异（p>0.05）。术前和术后冠状面（C-DAR）、矢状面（S-DAR）或总畸形角比值（T-DAR）无显著差异（p>0.05）。进行椎体切除减压术（VCR）的患者比例或平均固定节段数无差异。在轴向MRI切片上，使用脊髓形状面积以及长轴和短轴尺寸测量的脊髓变形无差异。然而，IONM信号丢失组的术中估计失血量（EBL）显著更高（1320.7±614.0 vs. 1049.0±468.4，p=0.0316）、氨甲环酸（TXA）用量更大（2619.8±1333.1 cc vs. 1925.9±1304.2，p=0.0372）和细胞回收血量更多（468.5±266.2 vs. 311.5±266.2，p=0.0264）。
在这项已报道的最大队列的接受脊柱畸形手术的T3SC患者中，发现与IONM信号丢失风险增加显著相关的唯一因素是更高的EBL、更高的自体回收输血量和更高的TXA用量。对于脊柱畸形外科医生来说，在治疗这一独特的高风险人群时，意识到血液和血流动力学管理的重要性至关重要。
