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Aborted AIS spinal fusion due to persistent loss of IONM: which patients are at greatest risk?

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Abstract

Purpose

Determine peri-operative risk factors predictive for prematurely stopping surgery prior to completion of deformity correction due to intra-operative neuromonitoring changes.

Methods

A single institution retrospective review of adolescent idiopathic scoliosis (AIS) patients that underwent spinal fusion for curves greater than 70°. Cases aborted due to persistent loss of IONM were compared to completed cases. Demographic, radiographic, neurologic, and surgical information was reviewed.

Results

There were 453 total cases. Nine (9/453: (2%)) cases were aborted due to persistent loss of IONM, and 4 (4/453; (0.88%)) awoke with a neurologic deficit. Comparing to the 444 completed cases, pre-operative risk factors associated with case abortion were older age (15.3 vs. 13.8 years; p = 0.02), sex (male) (66.7% vs. 20.3%, p = 0.004), and larger cobb angles (87.6° vs. 79.2°; p = 0.01). Being male increased the risk of case abortion: 7.9X.

Intraoperative risk factors associated with case abortion were combined anterior/posterior approach (ASF/PSF) (44.4% vs. 7.2%; p = 0.003) and increased index procedure EBL (1127 vs. 769 mL; p = 0.043). ASF/PSF increased the risk: 10.3X.

Four (4/9;44%) of the aborted cases awoke with neurologic deficit. Motor strength returned at 2.3 days (0–18). Aborted cases returned to the OR after 12.6 ± 7.0 days (1–23) which was related to time to regain motor strength.

Conclusion

Pre-operative risk factors for AIS case abortion due to persistent loss of IOMN are older age, males, with larger Cobb angles. Intraoperative risk factors are combined ASF/PSF and increased index procedure EBL. Independent risk factors were sex (male) and ASF/PSF which increased the risk 7.9X and 10.3X, respectively.

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA

    Lydia Klinkerman & Amy L. McIntosh

  2. UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Evan Fene & Claire Bonnyman

  3. Department of Orthopedics, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI, 96859, USA

    Connor Zale

Authors
  1. Connor Zale
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  2. Evan Fene
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  3. Claire Bonnyman
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  4. Lydia Klinkerman
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  5. Amy L. McIntosh
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr. CZ, Dr. EF, Dr. CB, Ms. LK, and Dr. ALM. The first draft of the manuscript was written by Dr. CZ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. CZ, MD: Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approval final version to be publish. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EF, MD: Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approval final version to be publish. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CB, MD: substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approval final version to be publish. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LK, BS: substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approval final version to be publish. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. ALM, MD: substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approval final version to be publish. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Amy L. McIntosh.

Ethics declarations

Conflict of interest

Dr. Connor Zale, Dr. Evan Fene, Dr. Claire Bonnyman, and Ms. Lydia Klinkerman have no relevant financial or non-financial interests to disclosure. Dr. Amy L McIntosh has no competing interests to declare that are relevant to the content of the article, however, does report being a paid speaker for NuVasive.

Ethical approval

Approval was granted for this study by our institution’s IRB, UT Southwestern (Study ID: 022017-011). This research study was conducted retrospectively from data obtained for clinical purposes.

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Not applicable.

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Zale, C., Fene, E., Bonnyman, C. et al. Aborted AIS spinal fusion due to persistent loss of IONM: which patients are at greatest risk?. Spine Deform 12, 681–687 (2024). https://doi.org/10.1007/s43390-024-00831-0

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  • DOI: https://doi.org/10.1007/s43390-024-00831-0

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