318. Severe pediatric deformity surgery had frequent IOM alerts but a low rate of permanent deficits at two years

Abstract

BACKGROUND CONTEXT Surgical treatment of severe pediatric spinal deformity is challenging and can have a high risk of neurologic injury. We investigated the incidence of intraoperative monitoring (IOM) alerts during surgery and the development of new neurologic deficits in a prospective multicenter cohort. PURPOSE The purpose of this study was to evaluate the frequency of IOM alerts during surgery for severe pediatric deformity and determine the incidence of new permanent deficits at 2 years postoperative. STUDY DESIGN/SETTING Prospective observational multicenter cohort of severe pediatric deformity patients treated surgically for minimum curves of 100° or planned vertebral column resection (VCR). PATIENT SAMPLE Patients with a minimum spinal deformity curve of 100° or who were scheduled for a VCR procedure were prospectively enrolled at 17 sites. OUTCOME MEASURES IOM alerts, radiographic parameters, surgical procedures, neurological status. METHODS Patients with severe spinal deformity with minimum curves of 100°; or planned VCR were followed for a minimum 2 years postoperative. We studied x-ray parameters, IOM changes, postop deficits and recovery at minimum 2 years. RESULTS A total of 228 of the 312 patients enrolled had a minimum two years follow-up (QOLs and x-rays). Of these, 110 patients had a VCR and 1 a PSO. Two hundred twelve had a post-only approach and 16 a combined anterior/posterior. Two hundred twenty-eight patients had a total of 272 procedures including all stages; IOM alerts occurred in 102/272 procedures (38%). IOM alerts occurred in 98 pts (43%), with a total of 147 IOM alerts. An analysis was completed between a VCR, ant/post, coronal deformity angular ratio (C–DAR), the sagittal deformity angular ratio (S–DAR), and any IOM alert, SSEP, TCeMEP or both. Only S-DAR was predictive for any IOM alert (p CONCLUSIONS Pediatric patients with severe deformity had a 43% incidence of IOM alerts but after addressing the alerts intraop, only 2 patients had new deficits at 2 years. Of the 19 patients with preoperative neurologic deficit, 16 patients improved or recovered. Neural monitoring should be mandatory in these cases. Sagittal DAR is associated with IOM alerts and new neurologic deficits. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.