A modified wake-up test for use in very young children undergoing spinal surgery

In a consecutive series of five very young children undergoing hemivertebre ctomy and fusion, a modified intraoperative wake-up test was used to confir m neurologic integrity. Standard leads attached to a nerve stimulator and p ositioned over the plantar aspect of each foot were used to apply tetanic e lectrical stimulation at the time of intraoperative wake-up. Four children responded vigorously with flexion and extension of the knees and ankles aft er only minimal delay. One neurologically intact child did not respond beca use of technical issues. This report describes our favorable preliminary ex perience with this technique.