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A novel MRI-based classification of spinal cord shape and CSF presence at the curve apex to assess risk of intraoperative neuromonitoring data loss with thoracic spinal deformity correction

Spine Deformity volume 8, pages 655–661 (2020)Cite this article

Abstract

Study design

Retrospective cohort.

Summary

We present a simple classification system that is able to identify patients with increased odds of losing intraoperative neuromonitoring data during thoracic deformity correction. Type 3 spinal cords, with the cord deformed against the concave pedicle in the axial plane, have ×28 greater odds of losing monitoring data during surgery.

Objectives

Assess preoperative morphology of the spinal cord across the thoracic concavity to predict intraoperative loss of neuromonitoring data.

Methods

128 consecutive patients undergoing surgical correction of a thoracic deformity with pedicle screw/rod constructs were included. Spinal cords were classified into 3 types based on the appearance of the cord on the axial-T2 MRI at the apex of the curve. Type 1 is defined as a circular/symmetric cord with visible CSF between the cord and the apical concave pedicle/vertebral body. Type 2 is a circular/oval/symmetric cord with no visible CSF between the concave pedicle and the cord. Type 3 is a spinal cord that is flattened/deformed by the apical concave pedicle or vertebral body, with no intervening CSF (Fig. 1).

Results

128 patients were reviewed: 81 (63%) Type 1; 32 (25%) Type 2; and 12 (11.7%) Type 3 spinal cords. Lower extremity trans-cranial motor-evoked Potentials (MEPs) and/or somatosensory evoked potentials (SSEPs) were lost intraoperatively in 21 (16%) cases, with full recovery of data in 20 of those cases. On regression analysis, a Type 1 cord was protective against intraoperative data loss (OR = 0.17, p = 0.0003). Type 2 cords had no association with data loss (OR = 0.66, p = 0.49). Type 3 cords had significantly higher odds of intraoperative data loss (OR = 28.3, p < 0.0001).

Conclusions

We present a new spinal cord risk classification scheme to identify patients with increased odds of losing spinal cord monitoring data with thoracic deformity correction. The odds of losing intraoperative MEPs/SSEPs are greater in type 3 spinal cords.

Level of evidence

III.

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Fig. 1
Fig. 2

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Funding

There was no financial support for this research project.

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Authors and Affiliations

  1. The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, The Spine Hospital, New York Presbyterian, Allen, 5141 Broadway, New York, NY, 10034, USA

    J. Alex Sielatycki, Meghan Cerpa, Griffin Baum, Martin Pham, Earl Thuet, Ronald A. Lehman & Lawrence G. Lenke

Authors
  1. J. Alex Sielatycki
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  2. Meghan Cerpa
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  3. Griffin Baum
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  4. Martin Pham
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  5. Earl Thuet
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  6. Ronald A. Lehman
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  7. Lawrence G. Lenke
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Contributions

JAS: Substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work. Drafting the work and revising it critically for important intellectual content. Final approval of the version to be published Contributed effort to the study. MC: Substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work. Drafting the work and revising it critically for important intellectual content. Final approval of the version to be published. Contributed effort to the study. GB: Substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work. Revising the work critically for important intellectual content. Final approval of the version to be published. Contributed effort to the study. MP: Substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work. Revising the work critically for important intellectual content. Final approval of the version to be published. Contributed effort to the study. ET: Substantial contributions to the acquisition, analysis, and interpretation of data for the work. Revising the work critically for important intellectual content. Final approval of the version to be published. Contributed effort to the study. RAL: Substantial contributions to the conception and design of the work. Revising the work critically for important intellectual content. Final approval of the version to be published. Contributed cases or effort to the study. LGL: Substantial contributions to the conception and design of the work. Revising the work critically for important intellectual content. Final approval of the version to be published. Contributed cases or effort to the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Meghan Cerpa.

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Ethical approval

Columbia University IRB Approved Protocol #AAAR9303.

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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This manuscript was accepted and presented at the 2018 Scoliosis Research Society Meeting.

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Sielatycki, J.A., Cerpa, M., Baum, G. et al. A novel MRI-based classification of spinal cord shape and CSF presence at the curve apex to assess risk of intraoperative neuromonitoring data loss with thoracic spinal deformity correction. Spine Deform 8, 655–661 (2020). https://doi.org/10.1007/s43390-020-00101-9

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  • DOI: https://doi.org/10.1007/s43390-020-00101-9

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