A comparative study of the intraoperative neurophysiological monitoring results during 3-column osteotomy surgery in severe congenital scoliosis with or without intraspinal anomalies

English Keywords:Congenital scoliosis  Intraspinal anomalies  3-column osteotomy  Intraoperative neurophysiological monitoring

English Abstract:

  【Abstract】 Objectives: To compare the intraoperative neurophysiological monitoring(IONM) results during 3-column osteotomy surgery in severe congenital scoliosis(CS) patients with or without intraspinal anomalies, and to explore the effect of intraspinal anomaly on the incidence of IONM alarm events and postoperative outcomes in CS patients. Methods: Clinical data of patients with severe CS who underwent 3-column osteotomy surgery in our hospital from September 2020 to May 2023 were retrospectively analyzed. The patients were divided into two groups according to whether combined with intraspinal anomalies. The basic information, the latency and amplitude of somatosensory evoked potentials(SSEPs) of both lower extremities, amplitude of transcranial electric motor evoked potentials(TCeMEPs), as well as the sensitivity and specificity of multimodal IONM were compared between the two groups. The incidence of IONM alarm events and postoperative outcomes were analyzed. Results: A total of 37 patients who met the criteria were included in the study, of which 14 patients combined with intraspinal anomalies, including 8 cases of syringomyelia, 2 case of tethered cord, 1 case of diastematomyelia, 1 case of diastematomyelia combined with tethered cord, and 2 cases of syringomyelia combined with tethered cord. The latency of SSEPs-P37 in the concave side lower extremity of CS patients with intraspinal anomalies was significantly longer than that of CS patients without intraspinal anomalies(40.9±3.3ms vs 38.0±3.7ms, P=0.03). In addition, the sensitivity and specificity of multimodal IONM were comparable between the two groups. There was no significant difference in the incidence of abnormal SSEPs, the incidence of IONM alarm events and the incidence of postoperative neurological symptoms between the two groups(P＞0.05). Conclusions: Multimodal IONM provides excellent monitoring effects in severe CS paitents undergoing 3-column osteotomy surgery. The latency of SSEPs-P37 in the concave side lower extremity of CS patients with intraspinal anomalies was significantly longer than that of CS patients without intraspinal anomalies. Intraspinal anomalies don′t increase the incidence of intraoperative IONM alarm events or the incidence of postoperative neurological complications.