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Spinal Cord Monitoring Data in Pediatric Spinal Deformity Patients With Spinal Cord Pathology

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Abstract

Study Design

Retrospective.

Objectives

The purpose of this study is to review the efficacy of monitoring data and outcomes in pediatric patients with spinal cord pathology.

Summary of Background Data

The incidence of spinal cord pathology in pediatric patients with scoliosis has been reported between 3% and 20%. Previous studies demonstrated that intraoperative spinal cord monitoring (IOM) during scoliosis surgery can be reliable despite underlying pathology.

Methods

A single-center retrospective review of 119 spinal surgery procedures in 82 patients with spinal cord pathology was performed. Diagnoses included Arnold-Chiari malformation, syringomyelia, myelomeningocele, spinal cord tumor, tethered cord, and diastematomyelia. Baseline neurologic function and history of prior neurosurgical intervention were identified. Outcome measures included ability to obtain reliable monitoring data during surgery and presence of postoperative neurologic deficits. Results were compared for 82 patients with adolescent idiopathic scoliosis (AIS).

Results

Usable IOM data were obtained in 82% of cases (97/119). Twenty-two cases (18%) had no lower extremity data. Patients with Arnold-Chiari malformation or syringomyelia pathologies, in isolation or together, had a significantly higher rate of reliable data compared to other pathologies (p!.0001). Among study group cases with usable data, there were 1 false negative (1%) and 4 true positive (4%) outcomes. There were no permanent neurologic deficits. The spinal cord pathology group demonstrated 80% sensitivity and 92% specificity.

Conclusions

Spinal cord monitoring is a valuable tool in pediatric patients with spinal cord pathology undergoing spinal deformity surgeries. When obtained, data allow to detect changes in spinal cord function. Patients with a diagnosis of Arnold-Chiari or syringomyelia have monitoring data similar to those patients with AIS. Patients with other spinal cord pathologies have less reliable data, and surgeons should have a lower threshold for performing wake-up tests to assess spinal cord function intraoperatively.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Alexander W. Aleem MD & Scott J. Luhmann MD

  2. Barnes-Jewish Hospital, St. Louis, MO, 63110, USA

    Earl D. Thuet BS & Anne M. Padberg MS

  3. Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Michael Wallendorf PhD

  4. 4S-60 St. Louis Children’s Hospital, 1 Children’s Place, St. Louis, MO, 63110, USA

    Scott J. Luhmann MD

  5. St. Louis Shriners Hospital, St. Louis, MO, 63110, USA

    Scott J. Luhmann MD

Authors
  1. Alexander W. Aleem MD
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  2. Earl D. Thuet BS
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  3. Anne M. Padberg MS
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  4. Michael Wallendorf PhD
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  5. Scott J. Luhmann MD
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Corresponding author

Correspondence to Scott J. Luhmann MD.

Additional information

Study conducted at Washington University School of Medicine, St. Louis Shriners Hospital for Children, and St. Louis Children’s Hospital, St. Louis, Missouri, USA.

Author disclosures: AWA (none); EDT (none); AMP (none); MW (none); SJL (none).

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Aleem, A.W., Thuet, E.D., Padberg, A.M. et al. Spinal Cord Monitoring Data in Pediatric Spinal Deformity Patients With Spinal Cord Pathology. Spine Deform 3, 88–94 (2015). https://doi.org/10.1016/j.jspd.2014.06.011

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  • DOI: https://doi.org/10.1016/j.jspd.2014.06.011

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