Study On The Application Of Mutimodal Intraoperative Monitoring In Scoliosis Surgery

Objective To evaluate the effect of Mutimodal intraoperative monitoring(MIOM)in scoliosis surgery,and explore the risk factors of intraoperative monitoring events.Methods Monitoring data at various surgery procedures in 70 cases of scoliosis treated in Yinchuan Guolong Hospital between January 2009 and February 2017 were reviewed.Combined monitoring of SEP,TES-MEP and Free-run EMG model were used during surgery.All patients presented no neurological deficits preoperatively.We measured the angle of coronal curve Cobb and sagittal thoracic kyphosis both preoperative and postoperative,then calculated the correction rate.The general data,surgery time,intraoperative blood loss,intraoperative neurophysiological monitoring,alarm factors and improvement measures,postoperative spinal cord injury and outcome were recorded.The risk factors of intraoperative monitoring events were analyzed according to the results of neurophysiological monitoring.Results In these cohort cases,combined monitoring of SEP+TES-MEP+Free-run EMG was successfully achieved in all 70 cases.On average,the major coronal curve was corrected from a preoperative 56.7°±18.5° to a postoperative 16.4°±6.8°,with a correction rate of 70.4%±8.4%.The sagittal kyphosis was corrected from a preoperative 52.9°±31.0° to a postoperative 26.5°±17.6°,with a correction rate of 50.9%±13.0%.The surgery time was 2.5~6.5h,with an average of(4.13±1.22)h.The average intraoperative blood loss was 150~3500ml,with an average of(952.56±785.96)ml.There were no false negative results in intraoperative electrophysiological monitoring.A total of 16 patients’ combined monitoring of SEP+TES-MEP+Free-run EMG were abnormal,among which 9 patients were confirmed to be true positive(7 cases during orthopedic procedure(osteotomy),2 cases during pedicle screw implanting),the other 7 cases were related to non operative factors.The sensitivity and the specificity of SEP + TES-MEP + Free-run EMG was 100%(9/9)and 88.5%(54/61),respectively.The false positive rate was 11.5%(7/61)and the false negative rate was 0.0%(0/9).12 cases monitored by SEP were abnormal,8 cases were confirmed to be true positive.The sensitivity and the specificity of SEP was 88.9%(8/9)and 93.4%(57/61),respectively.The false positive rate was 6.6%(4/61)and the false negative rate was 11.1%(1/9).10 cases monitored by TES-MEP were abnormal,7 cases were confirmed to be true positive.The sensitivity and the specificity of TES-MEP was 77.8%(7/9)and 95.1%(58/61),respectively.The false positive rate was 4.9%(3/61)and the false negative rate was 22.2%(2/9).11 cases monitored by Free-run EMG were abnormal,8 cases were confirmed to be true positive.The sensitivity and the specificity of Free-run EMG was 88.9%(8/9)and 95.1%(58/61),respectively.The false positive rate was 4.9%(3/61)and the false negative rate was 11.1%(1/9).In one patient diagnosed with neurofibromatosis who presented severe thoracic kyphosis preoperative,abnormality of SEP,TES-MEP and Free-run EMG was observed during the procedure,and temporary nerve dysfunction emerged postoperatively with a skin numbness in anterior lower right leg,which recovered after treatment of nourishing peripheral nerve and physical therapy.Conclusions 1.Application of MIOM in scoliosis surgery can monitor spinal cord and nerve root function roundly.2.MIOM has a high sensitivity,able to detect potential neurological damage in time,superior to single mode monitoring.3.Various factors contubute to MIOM monitoring events in scoliosis surgery.Osteotomy correction,pedicle screw implanting and thoracic kyphosis are high risk factors for severe MIOM events.