Abstract
Aim:
An analysis of significant neuromonitoring changes (NMCs) and evaluation of the efficacy of multimodality neuromonitoring in spinal deformity surgery.
Method:
A retrospective review of prospectively collected data in 320 consecutive paediatric and adult spinal deformity operations. Patients were sub-grouped according to demographics (age, gender), diagnosis, radiographic findings (Cobb angles, MR abnormalities) and operative features (surgical approach, duration, levels of fixation). Post-operative neurological deficit was documented and defined as either spinal cord or nerve root deficit.
Results:
296 paediatric and adult patients were monitored in 320 consecutive spinal deformity operations between 2003 and 2013. Combined monitoring with SSEPs and MEPs was considered successful (296 of 320 operations), when it was able to produce reproducible signals with regards to SEP and / or MEP. SEP was attempted but unrecordable in 1 case, while MEPs were contraindicated in 23 cases due to epilepsy and/or medications. The overall incidence of significant NMC was 7.5% (24 NMCs out of 320 operating episodes) and overall neurological deficit was 1.6%. There were 19 true positives, 5 false positives and zero false negative results.
When results were collated, the overall combined sensitivity of multimodal monitoring was 100%, specificity 98.3%, PPV 79.2% and NPV 98.3%.
Discussion:
Multimodal monitoring allows accurate assessment and prevention of permanent neurological deficit that is superior to any single monitoring modality.
Conflict Of Interest Statement: No conflict of interest.
