Efficacy of intraoperative monitoring for pediatric patients with spinal cord pathology undergoing spinal deformity surgery

Study Design. A retrospective study of 38 pediatric patients with spinal co rd pathology who underwent corrective spinal deformity surgery from January 1989 through June 1998. Objectives. To report reliability and specificity in obtaining intraoperati ve data in this population. These data were compared with monitoring result s obtained in a group of pediatric patients with idiopathic scoliosis. Summary of Background Data. Reports in the literature suggest intraoperativ e monitoring for patients with spinal cord pathology may be of limited valu e. No optimal monitoring protocol has been suggested for this population. Methods. The study group consisted of 38 pediatric patients with a diagnosi s of spinal cord pathology who underwent corrective spinal deformity surger y from January 1989 through June 1998. All patients had lower extremity fun ction. Somatosensory and neurogenic motor evoked potentials were used to mo nitor neurologic status during surgery. These data were compared with data obtained in 429 pediatric patients with idiopathic scoliosis. Study patient s were divided into Group I, those who had had spinal cord surgery (n = 20) , and Group II, those who had not (n = 18). Results. Somatosensory evoked potentials were obtained in 93.2% end remaine d consistent with baselines in 87.2% of the study group patients. Neurogeni c motor evoked potentials were obtained in 50.8% of the study subjects and remained consistent in 76.6% of those cases. The false-positive rate was 27 .1% in the study group, compared with 1.4% in the group with idiopathic sco liosis. The study group had no true-positive or false-negative findings. Gr oup I data differed from Group II data. Conclusions. Intraoperative monitoring should be used in patients with spin al cord pathology who undergo surgery for spinal deformity. Monitoring shou ld not miss a neurologic deficit but demonstrates greater variability, resu lting in more frequent use of an intraoperative wake-up test.