Hardy Sarah, Strantzas Samuel, Anthony Alison, Dermott Jennifer, Vandenberk Mike, Hassan Samer, Camp Mark, Lebel David E
Hospital for Sick Children, Toronto, Canada.
University of Waterloo, Waterloo, Canada.
Eur Spine J. 2025 Jun 13. doi: 10.1007/s00586-025-08988-6.
Intraoperative neurophysiological monitoring (IONM) is common practice during spine surgery and has been proven to be an accurate and reliable method for early detection of injury to neural structures. Drawbacks, however, include additional set-up time, financial cost, and particular anesthetic considerations. Although critical in high-risk procedures, the necessity of IONM in lower risk procedures, such as growing rod (GR) lengthenings, has not been extensively investigated. The aim of this study is to investigate the role of IONM during GR lengthening surgery. We hypothesize that it is reasonable to perform pediatric lengthening surgery in the absence of IONM.
Early onset scoliosis patients treated with GR between 2003 to 2023 who had routine IONM were retrospectively reviewed. Surgeries were categorized into implant placements, lengthenings, hardware exchanges and fusions. Descriptive statistics summarized baseline patient characteristics and surgical details. Neuromonitoring data for all procedures and any record of post-operative neurologic deficit were reviewed. Diagnostic sensitivity and specificity were calculated.
For the 62 patients included (mean age 6.62y, 54.8% female), 470 procedures were reviewed, of which 450 had neuromonitoring. Average initial and post-treatment Cobb angle were 83.5 ± 16.6 and 61.1 ± 20.4 degrees, respectively. Fourteen patients were still undergoing treatment. Procedures included 67 implant placements, 326 lengthenings, 55 fusions and 2 hardware exchanges. There were 32 alerts in 25 procedures: 18 implant placements (26.9%), 3 lengthenings (0.92%), and 11 fusions (20%). Of the 3 alerts that occurred during lengthening procedures, 2 were the result of surgical position, and 1 was related to traction to the ipsilateral brachial plexus post-distraction. Two occurred in the same patient, who had previously had a positional alert during implant placement. There were no neurological deficits. IONM specificity was as follows: total 93.0%, implants 74.6%, lengthenings 99.1% and fusions 81.0%. Sensitivity was 100% for all procedures.
Neuromonitoring alerts were most common during implant placements and fusion surgeries and occurred during less than 1% of lengthenings. Given the rare occurrence of IONM alerts during distractions, and the absence of neurological injury following these cases, we propose that IONM is not necessary for routine lengthening procedures. IONM is not always indicated and should be considered on a case-by-case basis. However, neuromonitoring remains prudent in cases with pre-existing neurological deficits, prior alerts, or when postoperative assessment is limited, as these factors may increase the risk of neural compromise.
术中神经生理监测（IONM）在脊柱手术中是常见操作，已被证明是早期检测神经结构损伤的准确且可靠的方法。然而，其缺点包括额外的设置时间、经济成本以及特殊的麻醉考量。尽管在高风险手术中至关重要，但IONM在低风险手术（如生长棒（GR）延长术）中的必要性尚未得到广泛研究。本研究的目的是探讨IONM在GR延长手术中的作用。我们假设在没有IONM的情况下进行小儿延长手术是合理的。
回顾性分析2003年至2023年期间接受GR治疗且进行常规IONM的早发性脊柱侧凸患者。手术分为植入物放置、延长、硬件更换和融合。描述性统计总结了患者的基线特征和手术细节。回顾了所有手术的神经监测数据以及任何术后神经功能缺损的记录。计算诊断敏感性和特异性。
纳入62例患者（平均年龄6.62岁，54.8%为女性），共回顾了470例手术，其中450例进行了神经监测。初始和治疗后平均Cobb角分别为83.5±16.6度和61.1±20.4度。14例患者仍在接受治疗。手术包括67例植入物放置、326例延长、55例融合和2例硬件更换。25例手术中有32次警报：18例植入物放置（26.9%）、3例延长（0.92%）和11例融合（20%）。在延长手术期间发生的3次警报中，2次是手术体位导致的，1次与牵引后同侧臂丛神经有关。2次发生在同一患者身上，该患者在植入物放置期间曾有过体位警报。没有神经功能缺损。IONM的特异性如下：总体为93.0%，植入物为74.6%，延长为99.1%，融合为81.0%。所有手术的敏感性均为100%。
神经监测警报在植入物放置和融合手术期间最为常见，在延长手术中发生率不到1%。鉴于在牵引过程中IONM警报罕见，且这些病例后未出现神经损伤，我们建议常规延长手术无需IONM。IONM并非总是必需的，应根据具体情况考虑。然而，对于存在既往神经功能缺损、既往警报或术后评估受限的病例，神经监测仍然是谨慎的选择，因为这些因素可能增加神经损伤的风险。
