Clin Surg | Volume 4, Issue 1 | Research Article | Open Access

Intraoperative Neuromonitoring in Pediatric Spinal Deformity Surgery: Risk Factors Analysis about 1048 Cases

Martine Gavaret1,2,3*, Sébastien Pesenti4,5,6,7, Daniela Pennaroli8, Marieme Soda Diop-Sene8, Elie Choufani5, Jeffrey J Varghese6, Gérard Bollini5,7 and Jean-Luc Jouve5,7

1Paris Descartes University, France
2Department of Neurophysiology, GHU Paris Psychiatry Neurosciences, France
3INSERM UMR 1266, France
4CNRS UMR 7287, ISM, Marseille, France
5Department of Pediatric Orthopedics, Timone Hospital, Marseille, France
6Spine research laboratory, Hospital for Special Surgery, New York, USA
7Aix Marseille University, France
8Department of Neurophysiology, Timone Hospital, Marseille, France

*Correspondance to: Martine Gavaret 

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Background: In spinal deformity surgery, one of the primary goals is to avoid surgically induced neurological deficits. Neurophysiological Intraoperative Monitoring (NIOM) has been proposed as an effective means of decreasing permanent neurologic injury. Material and
Methods: In this retrospective study, a total of 1064 consecutive pediatric spinal procedures between 2004 and 2016, at a single institution, were reviewed (745 females, mean age: 12.6 years). There were 821 (77%) primary and 243 (23%) revision surgeries. NIOM included as possible the combination of somato-sensory evoked potentials with descending neurogenic evoked potentials, D-waves and motor evoked potentials.
Results: Sixteen patients were characterized by unreliable baseline data. Review of NIOM was thus performed in 1048 cases. These cases corresponded to 558 (53%) idiopathic and 490 (47%) nonidiopathic spine deviations. The overall incidence of significant alerts was 6% and overall permanent neurological deficit was 0.7%. There were six major neurological deficits. Two cases of delayed cord-level deficit occurred. NIOM revealed 975 true negatives (93.2%), 65 true positives (6%), 4 false positives (0.4%) and 4 false negatives (0.4%). The sensitivity of IOM was thus 94% while its specificity was 99%. Four etiologies were significantly associated with a higher rate of intraoperative and postoperative complications: post-thoracotomy scoliosis (p<0.001*), achondroplasia and other bone dystrophies (p<0.001*), neurofibromatosis type1 (p=0.045*) and mucopolysaccharidosis (p=0.005*).
Conclusion: Early NIOM detection affords the surgical team an opportunity to reverse impeding neurological sequelae. This large series of pediatric spinal deformity surgery demonstrated significantly higher rates of intra and postoperative complications in four etiologies. This has been already described in NF1, mucopolysaccharidosis and achondroplasia related spine deformities but not in post-thoracotomy scoliosis.


Scoliosis; Kyphosis; Neurofibromatosis type 1; Post-thoracotomy scoliosis


Gavaret M, Pesenti S, Pennaroli D, Diop-Sene MS, Choufani E, Varghese JJ, et al. Intraoperative Neuromonitoring in Pediatric Spinal Deformity Surgery: Risk Factors Analysis about 1048 Cases. Clin Surg. 2019; 4: 2455.

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