227. Is the axial spinal cord classification predictive of intraoperative neurologic alert for pediatric scoliosis patients? A validation study

Abstract

BACKGROUND CONTEXT Neurologic deficit is a devastating complication in pediatric spinal deformity surgery. Identification of high-risk patients may improve preoperative planning and assist in counseling of patients and families. PURPOSE We proposed to determine if the axial spinal cord classification as described by Sielatycki and Lenke would be associated with a high rate of intraoperative neuromonitoring alerts for pediatric scoliosis patients undergoing posterior spinal fusion surgery. STUDY DESIGN/SETTING Retrospective chart review study. PATIENT SAMPLE A total of 90 pediatric scoliosis patients. OUTCOME MEASURES n/a METHODS Pediatric scoliosis patients undergoing posterior spinal fusion were retrospectively reviewed at a single tertiary referral center. As MRI is not routinely obtained prior to surgery, only those patients with a preoperative MRI showing high quality axial imaging of the apex of the thoracic deformity were included. MRI was reviewed for spinal cord/ CSF architecture as described by Sielatycki and Lenke. Based on this classification there are 3 types of cords. Type 1: circular cord with visible CSF between the cord and the apical concave pedicle. Type 2: circular cord but no visible CSF at apical concavity. Type 3: cord deformed with no intervening CSF. Intraoperative neuromonitoring records and operative reports were reviewed to determine presence of a neurologic alert. Preoperative radiographs were used to measure Cobb angle, kyphosis and deformity angular ratio (total DAR = coronal DAR + sagittal DAR). RESULTS A total of 90 patients met inclusion criteria. Diagnoses included idiopathic scoliosis (74%), followed by congenital (9%), syndromic (7%), neuromuscular/other (10%). Rate of neurologic events was Type 1: 2% (1/41 patients), Type 2: 14.3% (4/28), Type 3: 52% (11/21, p CONCLUSIONS Although there may be bias in the cohort in that only patients considered to be higher risk have preoperative MRI imaging, the axial MRI spinal cord classification correlated with intraoperative neuromonitoring alerts in pediatric scoliosis patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.