Is the axial spinal cord classification predictive of intraoperative neurologic alert for pediatric scoliosis patients?
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Is the axial spinal cord classification predictive of intraoperative neurologic alert for pediatric scoliosis patients? An independent retrospective validation study Smitha E. Mathew1 · Todd A. Milbrandt1 · William J. Shaughnessy1 · Anthony A. Stans1 · A. Noelle Larson1 Received: 17 May 2020 / Accepted: 19 October 2020 © Scoliosis Research Society 2020
Abstract Purpose We sought to determine whether the axial spinal cord classification by Sielatycki et al. would be associated with increased intraoperative neuromonitoring (IONM) alerts for pediatric scoliosis patients undergoing posterior spinal fusion (PSF) surgery. Methods Children less than age 19 with scoliosis undergoing PSF were retrospectively reviewed. Axial-T2 MRI of the thoracic apex was reviewed for spinal cord/CSF architecture as described by Sielatycki et al.: Type 1—circular cord with visible CSF, Type 2—circular cord but no visible CSF at apical concavity, and Type 3—cord deformed with no intervening CSF. Intraoperative neuromonitoring reports, operative records and preoperative radiographs were reviewed. Results 90 patients met the inclusion criteria. Rate of neurologic events was Type 1: 2% (1/41 patients), Type 2: 14.3% (4/28), Type 3: 57.1% (12/21) (Type 1 vs 2 p = 0.06; Type 1 vs 3 p 50% or an increase in the latency of > 10%, as compared with baseline, or a loss of MEPs or an abrupt decrease in their amplitude of > 75% of the baseline values [5, 8]. Patients with significant IONM signal loss were further studied to identify the measures adopted to address neuromonitoring signal changes. A standardized checklist of corrective strategies was utilized, including adjustments to the anesthesia, increasing the mean arterial pressures, identification of low hemoglobin by assessment of arterial blood gases and correction by transfusion and discontinuation of spinal distraction or instrumentation.
Results A total of 90 patients undergoing PSF for scoliosis met the inclusion criteria. Patients were between the ages of 2 to 18 years (mean = 13.8 years, SD 2.9), with 31 males and 59 females. The most common diagnosis was idiopathic scoliosis (73%), followed by congenital (9%), syndromic (7%), neuromuscular/other scoliosis (11%) (Table 1). Based on the axial MRI classification of the spinal cord, 41 patients had a Type 1 cord (45.6%), 28 patients had a Type 2 cord (31.1%) and 21 patients had a Type 3 cord (23.3%). Thus, most of the pediatric scoliosis patients undergoing PSF surgery had a Type 1 cord. Overall, type 3 cord patterns were noted in 21% (14/66) of AIS patients, 12.5% (1/8) of the congenital patients, 16.6% (1/6) of the syndromic patients, and 50% (5/10) of the neuromuscular/other patients. There was no association between spinal cord type and diagnosis (p = 0.59). Further, there was no association between
Spine Deformity Table 1 Demographics and etiology Male Female Diagnoses Idiopathic Neuromuscular Congenital Syndromic Other
Total cohort
Patients with IONM alert
Type 1 cord
Type 2 cord
Type 3 cord
31 59
6 11
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