• David W Polly, Kent Rice, and Arvydas Tamkus.
• Neurodiagn J. 2016 Mar 1; 56 (1): 17-31.

IntroductionThere is variability in intraoperative neuromonitoring (IONM), anesthetic and surgical techniques for the treatment of pediatric spinal deformity. This study evaluates a series of patients treated at multiple centers utilizing transcranial motor and somatosensory evoked potentials (TcMEP and SSEP) and electromyography (EMG). The frequency of alerts and the intraoperative follow-up is reported.MethodsStandard patient demographics and IONM data were collected from a two-month cohort of pediatric spine deformity cases.ResultsData from 218 scoliosis patients were included from 46 facilities and 72 surgeons. Baseline upper and lower extremity TcMEP data were present in 96.7% and 93.9% patients respectively. Baseline upper and lower SSEPs were present in 99.5% and 95.4% respectively Surgical TCMEP alerts occurred in 19 (8.7%) patients during deformity correction (n = 11), placement of instrumentation (n = 5), decompression (n = 2), and closing (n = 1) with concurrent SSEP alerts occurring in five patients. Nine had TCMEP recovery, eight showed partial recovery and two did not recover. Additional alerts occurred due to: positioning (n = 16), inhalational agent change (n = 4), global physiological change (n = 4) and technical reasons (n = 2). A total of 2164 pedicle screws were tested. Of 197 (9.1%) screws that tested from 6-9 mA, 171 (65.4%) were left unchanged, 10 (51%) removed, eight (4.1%) repositioned with improved threshold, and eight (4.1%) without improvement. Of 26 screws that tested ≤ 5 milliamperes (mA), 17 (65.4%) were left unchanged, five (19.2%) removed, two (7.7%) repositioned with improved threshold, and two (7.7%) without improvement.ConclusionsIONM provides data that causes re-evaluation in about 10% of pediatric spinal deformity cases.

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