Reversible Intraoperative Neurophysiologic Monitoring Alerts in Patients Undergoing Arthrodesis for Adolescent Idiopathic Scoliosis: What Are the Outcomes of Surgery?
Confidence in intraoperative neurophysiologic monitoring (IONM) data can allow scoliosis surgeons to proceed with surgery even after a monitoring alert, assuming the recovery of signals. We sought to determine the outcomes of surgical treatment of adolescent idiopathic scoliosis (AIS) after a notabl...
Uložené v:
| Vydané v: | Journal of bone and joint surgery. American volume Ročník 98; číslo 17; s. 1478 - 1483 |
|---|---|
| Hlavní autori: | , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
United States
07.09.2016
|
| Predmet: | |
| ISSN: | 1535-1386 |
| On-line prístup: | Zistit podrobnosti o prístupe |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | Confidence in intraoperative neurophysiologic monitoring (IONM) data can allow scoliosis surgeons to proceed with surgery even after a monitoring alert, assuming the recovery of signals. We sought to determine the outcomes of surgical treatment of adolescent idiopathic scoliosis (AIS) after a notable IONM alert.
We identified 676 patients who underwent arthrodesis with use of IONM for the treatment of AIS. The patients were divided into 2 cohorts: those who experienced a lower-extremity IONM alert and those who did not. An alert was defined as a notable change in IONM data, specifically, a ≥50% drop in somatosensory evoked potentials (SSEPs) and/or in transcranial motor evoked potentials (tcMEPs).
Of the 676 patients, 36 (5.3%) experienced IONM alerts. Those patients had a larger preoperative major Cobb angle (mean of 61° ± 13° compared with 55° ± 12° for the no-alert group; p < 0.01), a greater number of levels fused (mean of 12 ± 2 compared with 11 ± 2; p < 0.01), a longer operative duration (mean of 357 ± 157 minutes compared with 298 ± 117 minutes; p < 0.01), a higher estimated blood loss (1,857 ± 1,323 mL compared with 999 ± 796 mL; p < 0.01), and a greater volume of autologous blood transfused (mean of 527 ± 525 mL compared with 268 ± 327 mL; p < 0.01). Among patients who experienced an alert and had a completed operation (34 of 36 patients), mean postoperative radiographic measurements were similar to those of the no-alert group in terms of the percentage of correction of the major Cobb angle (alert, 66% ± 13%; no alert, 64% ± 19%; p = 0.53) and of rib prominence (alert, 49% ± 36%; no alert, 47% ± 46%; p = 0.83) and measurement of thoracic kyphosis (alert, 23° ± 10°; no alert, 22° ± 2°; p = 0.58). The Scoliosis Research Society (SRS)-22 outcome scores were also similar between the 2 cohorts.
Notable IONM changes occurred in 5.3% of the patients who underwent arthrodesis for AIS. Those patients had larger preoperative deformity, a longer operative duration, a greater number of levels fused, a higher estimated blood loss, and a greater volume of autologous blood transfused. Return of IONM data guided the surgeon to safely complete the procedure in 34 of 36 patients, with correction similar to that of patients who did not experience an alert.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
|---|---|
| AbstractList | BACKGROUNDConfidence in intraoperative neurophysiologic monitoring (IONM) data can allow scoliosis surgeons to proceed with surgery even after a monitoring alert, assuming the recovery of signals. We sought to determine the outcomes of surgical treatment of adolescent idiopathic scoliosis (AIS) after a notable IONM alert.METHODSWe identified 676 patients who underwent arthrodesis with use of IONM for the treatment of AIS. The patients were divided into 2 cohorts: those who experienced a lower-extremity IONM alert and those who did not. An alert was defined as a notable change in IONM data, specifically, a ≥50% drop in somatosensory evoked potentials (SSEPs) and/or in transcranial motor evoked potentials (tcMEPs).RESULTSOf the 676 patients, 36 (5.3%) experienced IONM alerts. Those patients had a larger preoperative major Cobb angle (mean of 61° ± 13° compared with 55° ± 12° for the no-alert group; p < 0.01), a greater number of levels fused (mean of 12 ± 2 compared with 11 ± 2; p < 0.01), a longer operative duration (mean of 357 ± 157 minutes compared with 298 ± 117 minutes; p < 0.01), a higher estimated blood loss (1,857 ± 1,323 mL compared with 999 ± 796 mL; p < 0.01), and a greater volume of autologous blood transfused (mean of 527 ± 525 mL compared with 268 ± 327 mL; p < 0.01). Among patients who experienced an alert and had a completed operation (34 of 36 patients), mean postoperative radiographic measurements were similar to those of the no-alert group in terms of the percentage of correction of the major Cobb angle (alert, 66% ± 13%; no alert, 64% ± 19%; p = 0.53) and of rib prominence (alert, 49% ± 36%; no alert, 47% ± 46%; p = 0.83) and measurement of thoracic kyphosis (alert, 23° ± 10°; no alert, 22° ± 2°; p = 0.58). The Scoliosis Research Society (SRS)-22 outcome scores were also similar between the 2 cohorts.CONCLUSIONSNotable IONM changes occurred in 5.3% of the patients who underwent arthrodesis for AIS. Those patients had larger preoperative deformity, a longer operative duration, a greater number of levels fused, a higher estimated blood loss, and a greater volume of autologous blood transfused. Return of IONM data guided the surgeon to safely complete the procedure in 34 of 36 patients, with correction similar to that of patients who did not experience an alert.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Confidence in intraoperative neurophysiologic monitoring (IONM) data can allow scoliosis surgeons to proceed with surgery even after a monitoring alert, assuming the recovery of signals. We sought to determine the outcomes of surgical treatment of adolescent idiopathic scoliosis (AIS) after a notable IONM alert. We identified 676 patients who underwent arthrodesis with use of IONM for the treatment of AIS. The patients were divided into 2 cohorts: those who experienced a lower-extremity IONM alert and those who did not. An alert was defined as a notable change in IONM data, specifically, a ≥50% drop in somatosensory evoked potentials (SSEPs) and/or in transcranial motor evoked potentials (tcMEPs). Of the 676 patients, 36 (5.3%) experienced IONM alerts. Those patients had a larger preoperative major Cobb angle (mean of 61° ± 13° compared with 55° ± 12° for the no-alert group; p < 0.01), a greater number of levels fused (mean of 12 ± 2 compared with 11 ± 2; p < 0.01), a longer operative duration (mean of 357 ± 157 minutes compared with 298 ± 117 minutes; p < 0.01), a higher estimated blood loss (1,857 ± 1,323 mL compared with 999 ± 796 mL; p < 0.01), and a greater volume of autologous blood transfused (mean of 527 ± 525 mL compared with 268 ± 327 mL; p < 0.01). Among patients who experienced an alert and had a completed operation (34 of 36 patients), mean postoperative radiographic measurements were similar to those of the no-alert group in terms of the percentage of correction of the major Cobb angle (alert, 66% ± 13%; no alert, 64% ± 19%; p = 0.53) and of rib prominence (alert, 49% ± 36%; no alert, 47% ± 46%; p = 0.83) and measurement of thoracic kyphosis (alert, 23° ± 10°; no alert, 22° ± 2°; p = 0.58). The Scoliosis Research Society (SRS)-22 outcome scores were also similar between the 2 cohorts. Notable IONM changes occurred in 5.3% of the patients who underwent arthrodesis for AIS. Those patients had larger preoperative deformity, a longer operative duration, a greater number of levels fused, a higher estimated blood loss, and a greater volume of autologous blood transfused. Return of IONM data guided the surgeon to safely complete the procedure in 34 of 36 patients, with correction similar to that of patients who did not experience an alert. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Author | Lonner, Baron S Cahill, Patrick J Asghar, Jahangir K Bennett, James T Yaszay, Burt Samdani, Amer F Newton, Peter O Pahys, Joshua M Miyanji, Firoz Betz, Randal R Ames, Robert J Orlando, Giuseppe Lehman, Jr, Ronald A |
| Author_xml | – sequence: 1 givenname: Amer F surname: Samdani fullname: Samdani, Amer F email: amersamdani@gmail.com organization: Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania amersamdani@gmail.com – sequence: 2 givenname: James T surname: Bennett fullname: Bennett, James T organization: Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania – sequence: 3 givenname: Robert J surname: Ames fullname: Ames, Robert J organization: Temple University School of Medicine, Philadelphia, Pennsylvania – sequence: 4 givenname: Jahangir K surname: Asghar fullname: Asghar, Jahangir K organization: Nicklaus Children's Hospital, Miami, Florida – sequence: 5 givenname: Giuseppe surname: Orlando fullname: Orlando, Giuseppe organization: Department of Orthopaedics and Traumatology, University of Messina, Messina, Italy – sequence: 6 givenname: Joshua M surname: Pahys fullname: Pahys, Joshua M organization: Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania – sequence: 7 givenname: Burt surname: Yaszay fullname: Yaszay, Burt organization: Rady Children's Hospital, San Diego, California – sequence: 8 givenname: Firoz surname: Miyanji fullname: Miyanji, Firoz organization: BC Children's Hospital, Vancouver, British Columbia, Canada – sequence: 9 givenname: Baron S surname: Lonner fullname: Lonner, Baron S organization: Mount Sinai Beth Israel Medical Center, New York, NY – sequence: 10 givenname: Ronald A surname: Lehman, Jr fullname: Lehman, Jr, Ronald A organization: Washington University School of Medicine, St. Louis, Missouri – sequence: 11 givenname: Peter O surname: Newton fullname: Newton, Peter O organization: Rady Children's Hospital, San Diego, California – sequence: 12 givenname: Patrick J surname: Cahill fullname: Cahill, Patrick J organization: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania – sequence: 13 givenname: Randal R surname: Betz fullname: Betz, Randal R organization: Institute for Spine & Scoliosis, Lawrenceville, New Jersey |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27605692$$D View this record in MEDLINE/PubMed |
| BookMark | eNo10E1PGzEQBmALUZEQOHJFPnJJ6o_Yu8sFpQjaRClUTRHHyLuezRptPFvbi5Q_1N_Jqk1PM9I882o05-TUowdCrjibCc7059WX1WbG1YxxmRUnZMyVVFMucz0i5zG-Mcbmc5adkZHINFO6EGPy5ye8Q4iubIEufQoGOwgmuXegT9AH7JpDdNjizlX0O3qXMDi_o4sWQorUefpjwOCH_sVbCDv8Ow2pCWghukhrDHRhsYVYDYwurcPOpGaI21TYOhzMLX1tTBq2gKYG6HOfKtxDpFjTTR92EA53F-RTbdoIl8c6IS-PD7_uv03Xz1-X94v1tJIyz6dQ2AxkpaDUVjPIQOWKCauUmdeM56xQwjBelFWthajqvFTz0upaGikEZEUtJuTmX24X8HcPMW33bji8bY0H7OOW5zyXUuuMD_T6SPtyD3bbBbc34bD9_1vxAfZPfxs |
| CitedBy_id | crossref_primary_10_1007_s00586_025_09100_8 crossref_primary_10_1016_j_wneu_2018_04_162 crossref_primary_10_2106_JBJS_24_01353 crossref_primary_10_2106_JBJS_24_00386 crossref_primary_10_1186_s13018_025_05693_4 crossref_primary_10_1007_s00586_023_07837_8 crossref_primary_10_1007_s43390_021_00369_5 crossref_primary_10_1007_s43390_023_00688_9 crossref_primary_10_5435_JAAOS_D_17_00748 crossref_primary_10_1177_21925682231164344 crossref_primary_10_1302_1863_2548_13_180102 crossref_primary_10_1007_s43390_020_00205_2 crossref_primary_10_1097_BRS_0000000000002461 crossref_primary_10_1097_BRS_0000000000002784 crossref_primary_10_1007_s43390_020_00241_y crossref_primary_10_1007_s43390_024_00831_0 crossref_primary_10_1007_s00586_024_08263_0 crossref_primary_10_1007_s43390_020_00246_7 crossref_primary_10_1007_s43390_024_00944_6 crossref_primary_10_1016_j_clinph_2024_02_024 crossref_primary_10_2106_JBJS_23_00882 crossref_primary_10_1097_BSD_0000000000000969 crossref_primary_10_1097_BCO_0000000000001295 crossref_primary_10_1007_s00586_025_09226_9 crossref_primary_10_1016_j_spinee_2024_04_008 crossref_primary_10_1016_j_wneu_2017_02_002 crossref_primary_10_1177_21925682241256350 |
| ContentType | Journal Article |
| Copyright | Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated. |
| Copyright_xml | – notice: Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated. |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.2106/JBJS.15.01379 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| EISSN | 1535-1386 |
| EndPage | 1483 |
| ExternalDocumentID | 27605692 |
| Genre | Journal Article |
| GroupedDBID | .XZ 08P 0R~ 123 29K 34G 36B 39C 4.4 53G 5RE 5RS 6NX 8F7 AAAAV AAAXR AAFTM AAGIX AAHPQ AAIQE AAMOA AAQKA AASCR AAWTL AAXQO ABASU ABDIG ABJNI ABPMR ABVCZ ABXVJ ACCJW ACEWG ACGFS ACGOD ACIJW ACILI ACIWK ACLDA ACNWC ACPRK ACXJB ADGGA ADHPY AEETU AFCHL AFDTB AFMFG AFRAH AFUWQ AHMBA AHOMT AHQNM AHVBC AIJEX AINUH AJCLO AJIOK AJNWD AJZMW AKCTQ AKULP ALKUP ALMA_UNASSIGNED_HOLDINGS ALMTX AMJPA AMKUR AMNEI AOHHW BOWHD BQLVK BYPQX C45 CGR CS3 CUY CVF D-I DIWNM E3Z EBS ECM EEVPB EIF EJD ERAAH F5P FCALG GNXGY GQDEL H13 HLJTE IKREB IKYAY JG8 K-O L7B M5~ NPM O9- OCB OGEVE OHH OJAPA OPUJH OVD OVDNE OVIDH OVLEI OXXIT PZZ RLZ SJN TEORI TJB TSPGW VVN W1K WH7 YCJ YOC ZY1 ZZMQN ~H1 ~ZZ 7X8 ABPXF ABZZY ACBKD ACZKN ADKSD ADSXY AFBFQ AOQMC |
| ID | FETCH-LOGICAL-c3388-e9d7e3c5eb6d60e7e58502d55a4f0180952a019bcf622cf8b54bd6f3a322e79f2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 31 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=00004623-201609070-00008&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| IngestDate | Sun Nov 09 09:57:02 EST 2025 Wed Feb 19 01:56:52 EST 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 17 |
| Language | English |
| License | Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c3388-e9d7e3c5eb6d60e7e58502d55a4f0180952a019bcf622cf8b54bd6f3a322e79f2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| PMID | 27605692 |
| PQID | 1818336671 |
| PQPubID | 23479 |
| PageCount | 6 |
| ParticipantIDs | proquest_miscellaneous_1818336671 pubmed_primary_27605692 |
| PublicationCentury | 2000 |
| PublicationDate | 20160907 |
| PublicationDateYYYYMMDD | 2016-09-07 |
| PublicationDate_xml | – month: 9 year: 2016 text: 20160907 day: 7 |
| PublicationDecade | 2010 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Journal of bone and joint surgery. American volume |
| PublicationTitleAlternate | J Bone Joint Surg Am |
| PublicationYear | 2016 |
| SSID | ssj0004407 |
| Score | 2.3734376 |
| SecondaryResourceType | review_article |
| Snippet | Confidence in intraoperative neurophysiologic monitoring (IONM) data can allow scoliosis surgeons to proceed with surgery even after a monitoring alert,... BACKGROUNDConfidence in intraoperative neurophysiologic monitoring (IONM) data can allow scoliosis surgeons to proceed with surgery even after a monitoring... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 1478 |
| SubjectTerms | Adolescent Evoked Potentials, Somatosensory - physiology Female Humans Intraoperative Neurophysiological Monitoring - methods Male Scoliosis - physiopathology Scoliosis - surgery Spinal Fusion - methods Treatment Outcome |
| Title | Reversible Intraoperative Neurophysiologic Monitoring Alerts in Patients Undergoing Arthrodesis for Adolescent Idiopathic Scoliosis: What Are the Outcomes of Surgery? |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/27605692 https://www.proquest.com/docview/1818336671 |
| Volume | 98 |
| WOSCitedRecordID | wos00004623-201609070-00008&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1NT-MwELVg4cAFFvHNLhokroHGSeyES1XQIopEqShIvVWOM0aRqqQ0ZX8Sv3PHdvg4IaS9-JJYSpzxzJvx5D3GTshmdSfDKBBxwYOY05BTlAqMjnWiY4Nhpp3YhBwM0vE4G7YFt6Ztq3zzic5RF7W2NfIzikRpFAkhw-7sObCqUfZ0tZXQWGYrEUEZ29Ilx5_Ywilb8byalNiIs5uLm9FpaGk6I_kFonSR5Wrjf5_pJ1tvMSX0vBFssiWsttjrPbqOi3yK0LcV3HqGnuUbHCGHK2l4zwd-Y9sKH_SmOF80UFYw9IyrDThppKfaXZ1bWYUCm7IBQrvQe-eDgn5R1k7eWMOIjKus6Z5zsMzgNAuBcCbcvSzovbCB2sDI_47d3WaPV38eLq-DVpQh0JTNpgFmhcRIJ5iLQnRQIuUbHV4kiYqNIwNLuCLYmGsjONcmzZM4L4SJFHkOlJnhO-xHVVe4x0CFgpI_GeZIOaFKO4rnCQFCFarQkJ3wfXb8tuwTMnp7kqEqrF-aycfC77Nd_-0mM8_OMeGSMjSR8YNvzD5kawSAhOsZk7_YiqEtj7_Zqv67KJv5kbMmGgfD239RCdqN |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Reversible+Intraoperative+Neurophysiologic+Monitoring+Alerts+in+Patients+Undergoing+Arthrodesis+for+Adolescent+Idiopathic+Scoliosis%3A+What+Are+the+Outcomes+of+Surgery%3F&rft.jtitle=Journal+of+bone+and+joint+surgery.+American+volume&rft.au=Samdani%2C+Amer+F&rft.au=Bennett%2C+James+T&rft.au=Ames%2C+Robert+J&rft.au=Asghar%2C+Jahangir+K&rft.date=2016-09-07&rft.eissn=1535-1386&rft.volume=98&rft.issue=17&rft.spage=1478&rft.epage=1483&rft_id=info:doi/10.2106%2FJBJS.15.01379&rft.externalDBID=NO_FULL_TEXT |