Article Sidebar

PDF
Date Published: 03/11/2023
Online Published: 20/11/2023
Abstract Views: 181
Views PDF: 104
DOI: https://doi.org/10.58490/ctump.2023i68.2257
Issue
No. 68 (2023)
Section
Article
How to Cite
Dau, T. C., & Vo, Q. D. N. (2023). INITIAL EVALUATION OF INTRA-OPERATIVE NEUROMONITORING SIGNAL CHANGES DURING SEVERE KYPHOSCOLIOSIS SURGERY WITHOUT VERTEBRAL COLUMN RESECTION AT HOSPITAL FOR TRAUMATOLOGY AND ORTHOPAEDICS. Cantho Journal of Medicine and Pharmacy, 68, 124-130. https://doi.org/10.58490/ctump.2023i68.2257

INITIAL EVALUATION OF INTRA-OPERATIVE NEUROMONITORING SIGNAL CHANGES DURING SEVERE KYPHOSCOLIOSIS SURGERY WITHOUT VERTEBRAL COLUMN RESECTION AT HOSPITAL FOR TRAUMATOLOGY AND ORTHOPAEDICS

The Canh Dau1,, Quang Dinh Nam Vo1
1 Hospital for Traumatology and Orthopedics

Main Article Content

Abstract

Background: Spinal cord injury is a rare complication that causes serious sequelae in spinal deformity surgery. Objective: To describe the relation of intra-operative neuromonitoring (IONM) signal changes during posterior spinal fusion (PSF) without vertebral column resection (VCR) to other factors in severe kyphoscoliosis surgery at Hospital for Traumatology and Orthopedic. Materials and methods: Retrospective review of severe pediatric spinal deformity patients treated with PSF without VCR or three-column osteotomy from 2013 to 2022. Exclusion criteria were prior instrumentation, lack of IONM, and incomplete radiographic data. Coronal DAR(C-DAR), sagittal DAR (S-DAR), total DAR (T-DAR), Cobb’ Angle, kyphosis, age, and etiology were collected and compared between patients with IONM signal loss and those without. Results: Thirty-two patients met the inclusion criteria. Five of thirty-two (15.6%) patients had abnormal IONM signal. In our study, IONM signals loss was not associated with increased kyphosis (p= 0.27), or Cobb’s angle (p= 0.16). S-DAR (p= 0.84), T-DAR (p= 0.27), C-DAR (p=0.19) and etiology (p= 0,16). The age (p=0.009), curve types (thoracic) (p=0.046) were significantly associated with IONM signal loss. Conclusion: Severe rigid spinal deformity carries a high risk of IOM signals loss. Our study found that abnormal IOM signals were closely related to preoperative age, curve types. However, a greater DAR was not associated with a higher risk of neurological injury. The study needs more cases to reduce bias statistics.

Article Details

Keywords

Intraoperative neuromonitoring (IOMN), Deformity angular ratio (DAR), non vertebrae column resection (non-VCR)

References

1. Fehlings MG B D, Norvell DC, Dettori JR. The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference?, Spine (Phila Pa 1976), 2010. 35:S37– 46, doi: 10.1097/BRS.0b013e3181d8338e.
2. Illingworth KD S A, Skaggs DL, Andras LM, Deformity angular ratio is associated with neuromonitoring changes without a vertebral column resection: spinal deformity is more influential than type of surgery., Spine Deform, 2023. 11(14):951-956, doi: 10.1007/s43390-023-00669-y.
3. Jian Chen, X-x S, Wen-yuan Sui, Jing-fan Yang, Yao-long Deng, et al. Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases, BMC Neurology, 2020. 20(1):433. doi: 10.1186/s12883-020-02012-8.
4. Lee BH H S, Han S et al. Total deformity angular ratio as a risk factor for complications after posterior vertebral column resection surgery, Korean Neurosurg Society. 2018. 61:723–730, doi: 10.3340/jkns.2018.0125.
5. Lewis ND K S, Lenke LG et al. The deformity angular ratio: does it correlate with high-risk cases for potential spinal cord monitoring alerts in pediatric 3-column thoracic spinal deformity corrective surgery?, Spine (Phila Pa 1976), 2015. 40:E879–E885, doi: 10.1097/BRS.0000000000000984.
6. Pastorelli F, Di Silvestre M, Plasmati R, Michelucci R, et al. The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring, Eur Spine J, 2011. 20 Suppl 1 (Suppl 1), S105-114, doi: 10.1007/s00586-011-1756-z.
7. Rajappa D K M, Masapu D, et al., Multimodal intraoperative neurophysiological monitoring in spine surgeries: the experience at a spine centre through years. Asian Spine J, 15(6):728-738, doi: 10.31616/asj.2020.0400.
8. Seung Myung Wi S-M P, Sam Yeol Chang, Surgical Causes of Significant Intraoperative Neuromonitoring Signal Changes in Three-Column Spinal Surgery, Asian Spine J, 2021. 15(16): 831–839, doi: 10.31616/asj.2021.0078.
9. Wang S e a, The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients, BMC Neurology, 2020. 20(1):221. doi: 10.1186/s12883-020-01799-w.
10. Xiao-Bin Wang L G L, Earl Thuet et al, Deformity Angular Ratio Describes the Severity of Spinal Deformity and Predicts the Risk of Neurologic Deficit in Posterior Vertebral Column Resection Surgery, Spine (Phila Pa 1976), 2016. 41(18):1447-1455, doi: 10.1097/BRS.0000000000001547.
11. Xie J W Y, Zhao Z et al. Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100 degrees, Neurosurg Spine. 2012. 17:540–551, doi: 10.3171/2012.9.SPINE111026.
12. Zuckerman S L, Lenke L G, Cerpa M, Kelly M P, et al, Interobserver and intraobserver reliability of determining the deformity angular ratio in severe pediatric deformity curves, Spine Deform, 2021. 9 (2), 435-440, doi: 10.1007/s43390-020-00239-6.