• Austin Sanders, Lindsay Andras, Alison Lehman, Nancy Bridges, and David L Skaggs.
• *Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA †Department of Perioperative Services, Children's Hospital Los Angeles, Los Angeles, CA.
• Spine. 2017 Jan 1; 42 (1): 20-24.

Study DesignProspective review of consecutive patients.ObjectiveTo evaluate the incidence and raise awareness of electrode discoloration that can occur in the operating room when using neuromonitoring.Summary Of Background DataTo our knowledge there are no articles that discuss dermal discolorations following spine surgery.MethodsFollowing recognition of dermal discolorations in some patients, a prospective evaluation of all patients undergoing spine surgery with somatosensory-evoked potential and motor-evoked potential neuromonitoring using subdermal needle electrodes was carried out over a 16-month period for quality assurance and improvement.ResultsA total of 201 consecutive patients with mean age of 14 years (4-25) were prospectively evaluated. Sixteen percent (33/201) had dermal discolorations associated with neuromonitoring. There were no significant differences in mean age (P = 0.624), height (P = 0.308), weight (P = 0.899), or body mass index (P = 0.571) between the patients with and without dermal discolorations. There was also no difference in prevalence of dermal discoloration by diagnosis (P = 0.490) or location of grounding pad and occurrence of dermal discoloration between groups (P = 0.268). The only difference noted was that patients without dermal discoloration had an average monopolar cautery setting of 46.8 W compared to 40.5 W for patients with dermal discolorations (P = 0.042). Of the 33 patients with a dermal discoloration, 27% (9/33) of these were on both the upper and lower extremities, 21% (7/33) on only the upper extremities, and 52% (17/33) on only the lower extremities. None of the dermal discolorations were painful or tender, and all resolved by 6-month follow-up. One patient did not have any dermal discoloration but did experience two full-thickness burns around the electrodes in one leg. The incidence of burns in this series was 0.5% (1/201).ConclusionDermal discolorations occurred in 16% of patients undergoing neuromonitoring for spine surgery. These common discolorations were painless and resolved by 6 months. More significant burns were uncommon, occurring in less than 1%.Level Of Evidence3.

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