Introduction: Intra-operative neuromonitoring including somatosensory evoked potentials, motor evoked potentials, and electromyography, have replaced the Stagnara wake-up test to allow early detection of neurological change during paediatric spinal deformity surgery. It is important for surgeons to recognize alerts triggered by loss of these potentials and act accordingly to prevent iatrogenic neurological damage intra-operatively. This study was conducted to determine the sensitivity and specificity of neuromonitoring alerts in paediatric spinal deformity correction surgery.
Methods: A retrospective single-centre study of all patients undergoing spinal deformity surgery at a tertiary paediatric centre between 1 January 2017 and 31 December 2020 (inclusive) was conducted. Neuromonitoring alerts were identified through neurophysiology documentation, and these were correlated with neurological deficits documented in the patient record post-operatively.
Results: A total of 399 operations were included in the study, with 147 (35.7%) of these having a motor, or motor and sensory alert triggered. Fifteen (10.2% of alerts) of these patients had a post-operative neurological deficit, compared to seven (2.8% of no alerts) of those that had no neuromonitoring alert. The sensitivity for post-operative neurological deficits not resolving within 3 days was 100%, and the specificity was 65.5%.
Conclusion: Intra-operative neuromonitoring is highly sensitive to post-operative neurological deficits lasting longer than 3 days. However, there is still scope for optimization of specificity, with many false positives identified.
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http://dx.doi.org/10.1111/ans.19279 | DOI Listing |
Eur J Neurol
January 2025
Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Background: Magnetic resonance imaging may suggest spinal cord compression and structural lesions in degenerative cervical myelopathy (DCM) but cannot reveal functional impairments in spinal pathways. We aimed to assess the value of contact heat evoked potentials (CHEPs) in addition to MRI and hypothesized that abnormal CHEPs may be evident in DCM independent of MR-lesions and are related to dynamic mechanical cord stress.
Methods: Individuals with DCM underwent neurologic examination including segmental sensory (pinprick, light touch) and motor testing.
Orphanet J Rare Dis
December 2024
Centre de Référence Des Maladies Neuromusculaires AOC, CHU de Nantes, Filnemus, Euro-NMD, Hôtel Dieu, Nantes, France.
Background: Spinal muscular atrophy (SMA) patients benefit from pre-mRNA splicing modifiers targeting the SMN2 gene, which aims to increase functional SMN production. The animal toxicity affecting spermatogenesis associated with one such treatment raised questions about male SMA patients' spermatogenesis.
Methods: This descriptive, cross-sectional study was conducted from June 2022 to July 2023.
Spine J
December 2024
Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, Korea.
Background Context: Baseline severities of sagittal malalignment and degrees of pelvic compensation may affect postsurgical outcomes differently after adult spinal deformity (ASD) surgery, even if the patients achieved optimal correction of sagittal malalignment.
Purpose: To investigate whether postsurgical outcomes vary according to baseline sagittal alignment and pelvic compensation status in patients achieving adequate correction relative to age-adjusted alignment target in ASD surgery.
Study Design/setting: Retrospective study PATIENT SAMPLE: Patients who underwent ≥ 5-level fusion to the pelvis for ASD; achieved matched correction relative to age-adjusted pelvic incidence (PI)-lumbar lordosis (LL); and completed ≥ 2-year follow-up.
Spine J
December 2024
Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; Rocky Mountain Scoliosis and Spine, Denver, CO, USA.
Spine J
December 2024
Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Background Context: The effect of romosozumab administration in patients undergoing corrective spinal fusion surgery has not yet been analyzed.
Purpose: To examine the effect of romosozumab administration on reducing the incidence of proximal junctional kyphosis (PJK), particularly PJK due to fractures (PJK-Fx), in patients undergoing spinal corrective fusion surgery.
Design: Retrospective cohort study PATIENT SAMPLE: A total of 111 patients aged >50 years underwent corrective fusion surgery (>2 vertebrae) for adult spinal deformity or vertebral compression fracture between June 2010 and July 2023.
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