Intraoperative neurophysiology monitoring in scoliosis surgery in children

Lakshmi Nagarajan, Soumya Ghosh, David Dillon, Linda Palumbo, Peter Woodland, Priya Thalayasingam, Martyn Lethbridge

Research output: Contribution to journalArticle

Abstract

Objective: Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine deformity surgery. INM is being used increasingly despite conflicting opinions, varied results, non-standard alarm criteria and concern regarding cost effectiveness. In this paper we present our experience with INM in scoliosis and spine deformation surgery in children, propose alert criteria and preferred anaesthetics in clinical practice. Methods: We retrospectively analysed our experience with INM in 56 children who had 61 scoliosis and spine deformity surgeries. Results: INM was successfully undertaken with transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials. There were no injuries due to INM. Four children had 5 alerts during 4 surgeries. A postoperative deficit was seen in one child only. No new postoperative deficits were seen in any child who did not have an alert during INM. Total intravenous anaesthesia was better for INM compared to inhalational anaesthetics. Conclusions: INM is useful in scoliosis surgery; it is likely to mitigate the risk of new deficits following surgery. We recommend alert criteria for TcMEPs that include multiple facets – amplitude, stimulus paradigm, morphology. We recommend propofol and remifentanil, in preference to sevoflurane and remifentanil for anaesthesia during INM. Significance: Our study adds to the literature supporting the role of INM in scoliosis surgery in children. We provide guidelines for alarm criteria in clinical practice and recommend the use of total intravenous anaesthesia as the preferred anaesthetic option.

Original languageEnglish
Pages (from-to)11-17
Number of pages7
JournalClinical Neurophysiology Practice
Volume4
DOIs
Publication statusPublished - 1 Jan 2019

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Intraoperative Monitoring
Neurophysiology
Scoliosis
Anesthetics
Intravenous Anesthesia
Spine
Motor Evoked Potentials
Somatosensory Evoked Potentials
Propofol
Cost-Benefit Analysis
Anesthesia

Cite this

Nagarajan, L., Ghosh, S., Dillon, D., Palumbo, L., Woodland, P., Thalayasingam, P., & Lethbridge, M. (2019). Intraoperative neurophysiology monitoring in scoliosis surgery in children. Clinical Neurophysiology Practice, 4, 11-17. https://doi.org/10.1016/j.cnp.2018.12.002
Nagarajan, Lakshmi ; Ghosh, Soumya ; Dillon, David ; Palumbo, Linda ; Woodland, Peter ; Thalayasingam, Priya ; Lethbridge, Martyn. / Intraoperative neurophysiology monitoring in scoliosis surgery in children. In: Clinical Neurophysiology Practice. 2019 ; Vol. 4. pp. 11-17.
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Nagarajan, L, Ghosh, S, Dillon, D, Palumbo, L, Woodland, P, Thalayasingam, P & Lethbridge, M 2019, 'Intraoperative neurophysiology monitoring in scoliosis surgery in children' Clinical Neurophysiology Practice, vol. 4, pp. 11-17. https://doi.org/10.1016/j.cnp.2018.12.002

Intraoperative neurophysiology monitoring in scoliosis surgery in children. / Nagarajan, Lakshmi; Ghosh, Soumya; Dillon, David; Palumbo, Linda; Woodland, Peter; Thalayasingam, Priya; Lethbridge, Martyn.

In: Clinical Neurophysiology Practice, Vol. 4, 01.01.2019, p. 11-17.

Research output: Contribution to journalArticle

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