Failure of Intraoperative Monitoring to Detect Postoperative Neurologic Deficits: A 25-year Experience in 12,375 Spinal Surgeries.

Study Design: Retrospective.

Objective: The purpose was to categorize and evaluate intraoperative monitoring (IOM) failure to detect neurologic deficits occurring during spinal surgery.

Summary Of Background Data: The efficacy of spinal cord/nerve root monitoring regarding undetected neurologic deficits is examined in a large, single institution series involving all levels of the spinal column and all spinal surgical procedures.

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

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%.

Significant change or loss of intraoperative monitoring data: a 25-year experience in 12,375 spinal surgeries.

Study Design: Retrospective.

Objective: The purpose of this study was to report the spectrum of intraoperative events responsible for a loss or significant change in intraoperative monitoring (IOM) data.

Summary Of Background Data: The efficacy of spinal cord/nerve root monitoring is demonstrated in a large, single institution series of patients, involving all levels of the spinal column (occiput to sacrum) and all spinal surgical procedures.

Validity and reliability of intraoperative monitoring in pediatric spinal deformity surgery: a 23-year experience of 3436 surgical cases.

Study Design: This was a 23-year retrospective study of 3436 consecutive pediatric orthopedic spinal surgery patients between 1995 and 2008.

Objective: To demonstrate the effectiveness of multimodality electrophysiologic monitoring in reducing the incidence of iatrogenic neurologic deficit in a pediatric spinal surgery population.

Summary Of Background Data: The elective nature of many pediatric spinal surgery procedures continues to drive the need for minimizing risk to each individual patient.

Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do?

Study Design: A retrospective review of pediatric kyphosis patients undergoing a spinal cord-level osteotomy for correction.

Objective: To evaluate the prevalence, etiology, timing, and intervention related to loss of spinal cord monitoring data during surgical correction of pediatric kyphosis in the spinal cord region.

Summary Of Background Data: Although much has been written regarding the risks inherent to scoliosis surgery, there is less literature available regarding the neurologic outcomes of pediatric kyphosis surgery.

Correlation between low triggered electromyographic thresholds and lumbar pedicle screw malposition: analysis of 4857 screws.

Study Design: A retrospective analysis of 1078 spinal surgical procedures with lumbar pedicle screw placement at a single institution.

Objective: Based on previously established normative values, triggered electromyographic stimulation (TrgEMG) was re-examined to evaluate its efficacy in determining screw malposition.

Summary Of Background Data: Threshold values for confirmation of intraosseous placement of pedicle screws with EMG stimulation is controversial.

The utility of somatosensory evoked potential monitoring during cervical spine surgery: how often does it prompt intervention and affect outcome?

Study Design: Retrospective review of the results of somatosensory evoked potentials (SSEP) performed in cervical spine surgery.

Purpose: To evaluate the utility of spinal cord monitoring during cervical spine surgery in a single surgeon's practice, based on how often it prompted an intraoperative intervention.

Overview Of Literature: Intraoperative monitoring during cervical spine surgery is not a universally accepted standard of care.

Intraoperative electrophysiologic monitoring: considerations for complex spinal surgery.

Intraoperative neurophysiologic monitoring techniques have evolved as the complexity of spinal surgery has increased and the limitations of individual modalities have become apparent. Current monitoring strategies include a combination of techniques directed toward detecting changes in sensory, motor, and nerve root function. Close coordination and communication between the monitoring personnel, surgeon, and anesthesiologist is essential to effective intraoperative monitoring.

Increased risk of postoperative neurologic deficit for spinal surgery patients with unobtainable intraoperative evoked potential data.

Study Design: This was a retrospective study of 4,310 patients undergoing spinal surgery between 1994 and 2003.

Objectives: To examine the incidence and potential causality of unobtainable somatosensory evoked potential (SSEP) and neurogenic mixed evoked potential (NMEP) data for a population of spinal surgery patients.

Summary Of Background Data: Patients with absent or unobtainable evoked potential data may increase the risk of undetected neurologic injury.

Can triggered electromyograph thresholds predict safe thoracic pedicle screw placement?

Study Design: A prospective clinical study of thoracic pedicle screws monitored with triggered electromyographic testing.

Objective: To evaluate the sensitivity of recording rectus abdominis triggered electromyographs to assess thoracic screw placement.

Summary Of Background Data: Triggered electromyographic testing from lower extremity myotomes has identified medially placed lumbar pedicle screws.

The significance of anode location for stimulus-evoked electromyography during iliosacral screw placement.

Objectives: To determine the effect of anode location on the current threshold required to provoke an electromyograph response during stimulus-evoked electromyography for iliosacral screw placement.

Design: Prospective cohort.

Setting: Level I trauma center.