Our Summary

This research paper is about a review of past studies regarding the use of intraoperative neurophysiological monitoring (IONM) during scoliosis surgery. Scoliosis surgery can sometimes unintentionally cause spinal cord injury, which can lead to nerve damage. IONM is a tool that allows doctors to detect these injuries early, leading to a better outcome for the patient.

The researchers looked at studies from 2012 to 2022 to find out if there are widely accepted warning signals for IONM that indicate a potential problem. They found that the rates of IONM alerts and instances of nerve damage varied widely across the studies they examined.

For two types of IONM, TcMEP and SSEP, they found that the warning signals also differed. For TcMEP, a drop in the strength of the signal between 50 to 90% was commonly used as a warning. For SSEP, a drop in the strength of the signal by 50% and/or a 10% increase in the time it takes for the signal to travel was commonly used as a warning.

In conclusion, these warning signals are important to help avoid unnecessary surgical procedures without increasing the risk of nerve damage. The most common cause of changes in IONM signals was the surgical procedure itself.

FAQs

  1. What is intraoperative neurophysiological monitoring (IONM) and how is it used in scoliosis surgery?
  2. What were the key findings of the research regarding warning signals of IONM during scoliosis surgery?
  3. Does the use of IONM in scoliosis surgery reduce the risk of nerve damage?

Doctor’s Tip

Therefore, it is important for patients undergoing pediatric scoliosis surgery to be aware of the potential benefits of IONM and to discuss this option with their surgeon. By using IONM during surgery, doctors can better monitor and protect the spinal cord and nerves, leading to a safer and more successful outcome. It is important for patients to follow their doctor’s recommendations and to ask any questions they may have about the use of IONM during their surgery.

Suitable For

Patients who are typically recommended for pediatric scoliosis surgery are those who have a severe curvature of the spine that is causing pain, difficulty breathing, or other issues that impact their quality of life. Surgery is usually recommended for patients who have a curve greater than 40-50 degrees, have not responded to non-surgical treatments, or have a progressive curve that is likely to worsen over time.

It is important for patients undergoing pediatric scoliosis surgery to be closely monitored during the procedure to ensure the safety and success of the surgery. The use of IONM can help detect any potential nerve damage early on, leading to better outcomes for the patient. By following the warning signals identified in this research paper, surgeons can make informed decisions during the surgery to prevent unnecessary complications and ensure the best possible outcome for the patient.

Timeline

Before pediatric scoliosis surgery, a patient may experience symptoms such as back pain, uneven shoulders or hips, and difficulty breathing. They may undergo imaging tests such as X-rays and MRIs to confirm the diagnosis of scoliosis and determine the severity of the curve.

After pediatric scoliosis surgery, the patient will typically spend a few days in the hospital recovering. They may experience pain, swelling, and limited mobility in the days and weeks following surgery. Physical therapy and rehabilitation will be necessary to regain strength and flexibility in the spine.

Over time, the patient will gradually return to their normal activities and may require regular follow-up appointments with their surgeon to monitor their progress. In some cases, additional surgeries or interventions may be necessary to correct any complications or issues that arise. With proper care and monitoring, most patients can achieve good outcomes and improved quality of life after pediatric scoliosis surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pediatric scoliosis surgery and the use of IONM may include:

  1. What is intraoperative neurophysiological monitoring (IONM) and why is it used during scoliosis surgery?
  2. How will IONM help prevent nerve damage during the surgery?
  3. What are the warning signals that the doctor will be looking for during the surgery?
  4. How often do these warning signals occur during scoliosis surgery?
  5. What steps will be taken if a warning signal is detected during the surgery?
  6. How will the use of IONM affect the overall outcome of the surgery?
  7. Are there any risks or complications associated with the use of IONM during scoliosis surgery?
  8. Are there any alternative methods or technologies that can be used instead of IONM for monitoring nerve function during the surgery?
  9. How experienced is the surgical team in using IONM during pediatric scoliosis surgery?
  10. What is the success rate of scoliosis surgery when IONM is used as a monitoring tool?

Reference

Authors: Angelliaume A, Alhada TL, Parent HF, Royer J, Harper L. Journal: Eur Spine J. 2023 Sep;32(9):3072-3076. doi: 10.1007/s00586-023-07837-8. Epub 2023 Jul 11. PMID: 37434021