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Is routine intraoperative neuromonitoring necessary in growing rod lengthening procedures? A retrospective, observational study

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Abstract

Purpose

To investigate whether intraoperative neuromonitoring (IONM) may be avoided in growing rod lengthening procedures in early onset scoliosis (EOS).

Methods

A total of 636 primary growing rod surgeries and lengthening procedures were performed in 112 patients with EOS. Traditional growing rods (TGR) or magnetically controlled growing rods (MCGR) were implanted and subsequent lengthening procedures were done at stipulated intervals. Combined multi-modality IONM was used in all index surgeries—but was only used in lengthening procedures in patients with existing spinal cord abnormality or a history of neurosurgical procedure for the same, patients with prior history of a neuromonitoring alert in their index surgery and when lengthening was accompanied by an implant exchange/revision. All the remaining growing rod lengthening procedures were carried out without IONM. Hospital records and operation notes were retrospectively reviewed with focus on details of neurological events/complications.

Results

In 112 primary growing rod applications (TGR = 96, MCGR = 16) and 524 lengthening procedures (TGR = 444, MCGR = 80), intraoperative neuromonitoring ‘alerts’ were encountered in 6/112 index surgeries and temporary postoperative neurological deficits were seen in 2/112 index surgeries. No intraoperative neuromonitoring event or postoperative neurological complication was encountered in 524 lengthening procedures—irrespective of whether they were carried out along with implant exchange, or in patients with spinal cord abnormality or prior neuromonitoring event during index surgery.

Conclusion

While IONM should be used in primary growing rod application surgeries, its use may be avoided in lengthening and implant exchange procedures in a resource-limited setting.

Level of evidence

Level 3.

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Funding

There is no funding source for this publication/study.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India

    Bhavuk Garg & Nishank Mehta

  2. All India Institute of Medical Sciences, New Delhi, India

    Subrat Mohapatra

Authors
  1. Bhavuk Garg
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  2. Subrat Mohapatra
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  3. Nishank Mehta
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Contributions

BG, SM, NM: concepts, design, definition of intellectual content, clinical studies, data acquisition, data analysis, manuscript preparation, manuscript editing, manuscript review and approval of final manuscript. SM, NM: literature search and statistical analysis.

Corresponding author

Correspondence to Nishank Mehta.

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Conflict of interest

Dr. Bhavuk Garg, Dr Subrat Mohapatra and Dr Nishank Mehta declare that they have no conflict of interest.

Ethics approval

Approval was obtained from the ethics committee of All India Institute of Medical Sciences, New Delhi. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study. Patients signed informed consent regarding publishing their data and photographs.

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Garg, B., Mohapatra, S. & Mehta, N. Is routine intraoperative neuromonitoring necessary in growing rod lengthening procedures? A retrospective, observational study. Spine Deform 8, 1369–1374 (2020). https://doi.org/10.1007/s43390-020-00163-9

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  • DOI: https://doi.org/10.1007/s43390-020-00163-9

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