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Utilization of pre-operative MRI to identify AIS patients at highest risk of intra-operative neuromonitoring alert

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Abstract

Purpose

Utility of pre-operative MRI for patients undergoing scoliosis correction has expanded to include an MRI classification for identifying patients at increased risk of experiencing intra-operative neuromonitoring (IONM) alerts based on the shape of the spinal cord and circumferential presence of CSF at the apex of the thoracic curve. In the present study, the authors explore the utility of this new MRI classification and multiple X-ray radiographic parameters in identifying the AIS sub-population at high risk of IONM alerts.

Methods

AIS patients < 18 years old who underwent posterior spinal fusion between 2018 and 2022 at a single institution. Imaging reviewed to determine main thoracic (MT) and thoraco-lumbar (TL) Cobb angles, major thoracic Apical Vertebral Translation (AVT) and lumbar/thoraco-lumbar AVT (TL AVT), thoracic kyphosis (TK), coronal main thoracic Deformity Angular Ratio (cDAR), sagittal DAR (sDAR), and MRI to determine the spinal cord type (1, 2, or 3).

Results

A total of 155 AIS patients who met the inclusion criteria between 2018 and 2022 were included. There was a trend to have an increased incidence of Type 3 spinal cord shape both with increase in the MT Cobb angle and MT AVT. There was also a shift toward more IONM alerts in patients with Type 3 (19.5%) spinal cords, AVT ≥ 5 cm (18.9%), and Cobb angle ≥ 650 (28.2%).

Conclusion

Higher magnitude of thoracic Cobb angle and AVT are associated with higher likelihood of type 3 spinal cord at the apex in MRI. Patients with Type 3 spinal cord, Cobb angle ≥ 650, AVT > 5 cm, and cDAR > 10 have higher likelihood to have IONM alerts. Patient with a Type 3 spinal cord and a Cobb angle ≥ 650 (50.0%), cDAR > 10 (43.7%), and AVT > 5 cm (35.2%) have the highest risk of having IONM alerts.

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Data availability

Data is available upon request from the corresponding author.

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Funding

No funding was received for this project.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Tulane School of Medicine, New Orleans, LA, USA

    Sassan Keshavarzi

  2. Department of Orthopedic Surgery, Center for Spinal Disorders, Nicklaus Children’s Hospital, Miami, FL, 33155, USA

    Subaraman Ramchandran, Thomas Errico & Stephen George

  3. Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

    Jeffrey Spardy

  4. Department of Orthopedic Surgery, Allegheny General Hospital, Pittsburg, PA, USA

    Alyssa Dobyns

Authors
  1. Sassan Keshavarzi
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  2. Subaraman Ramchandran
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  3. Jeffrey Spardy
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  4. Alyssa Dobyns
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  5. Thomas Errico
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  6. Stephen George
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Contributions

SR, SK, JS, AD, TE, and SG: data acquisition, manuscript preparation, approved the version to be published, and agreed to be accountable for all aspects of work.

Corresponding author

Correspondence to Subaraman Ramchandran.

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Conflict of interest

Dr. Thomas J. Errico is a speaker and consultant to Stryker. He also has royalties from Stryker. Dr. Stephen George is a consultant to Globus Medical. Dr. Subaraman Ramchandran, Dr. Sassan Keshavarzi, Dr. Alyssa Dobyns, and Jeffrey Spardy declare that they have no financial or non-financial interests to disclose.

Ethical approval

The manuscript submitted does not contain information about medical device(s).

IRB

The study was conducted under the IRB heading “Secondary analysis of data to study the clinical and radiographic outcomes in pediatric patients undergoing surgery for spinal deformities”. Protocol number: 2019064RI.

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Keshavarzi, S., Ramchandran, S., Spardy, J. et al. Utilization of pre-operative MRI to identify AIS patients at highest risk of intra-operative neuromonitoring alert. Spine Deform 11, 1419–1426 (2023). https://doi.org/10.1007/s43390-023-00710-0

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  • DOI: https://doi.org/10.1007/s43390-023-00710-0

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