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European Spine Journal

Open Access 05-04-2024 | Adolescent Idiopathic Scoliosis | Original Article

Risk factors for neurophysiological events related to intraoperative halo-femoral traction in spinal deformity surgery

Authors: Hanneke I. Berends, Agnita Stadhouder, Barend J. van Royen, Henricus L. Journée, Alida A. Gouw

Published in: European Spine Journal

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Abstract

Purpose

This study identifies risk factors for neurophysiological events caused by intraoperative halo-femoral traction (IOHFT) in patients with adolescent idiopathic scoliosis (AIS), and neuromuscular scoliosis (NMS).

Methods

Neurophysiological integrity was monitored using motor evoked potentials (MEPs). IONM event was defined as a decreased MEP amplitude of more than 80% of baseline in, at least, one muscle. Time between application of IOHFT and event, affected muscles, surgical stage, and time between removal of IOHFT and recovery of MEPs were described. Characteristics (age, height, weight, diagnosis, Cobb angle, and flexibility of the curve) of patients with and without IOHFT-events were compared using analysis of variance. Binary logistic regression analyses were performed to identify predictors.

Results

The study included 81 patients (age 15.6 ± 2.4 years, 53 females, AIS: n = 47, NMS n = 34). IOHFT-events occurred in 11 patients (13%; AIS n = 4, NMS n = 7). IOHFTevents affecting all limbs occurred pre-incision in NMS. Events affecting only the legs occurred during all stages of surgery. Patients with IOHFT-events were smaller (p = 0.009) and had stiffer curves (p = 0.046). Height was a predictor (odds ratio, 0.941; 95% confidence interval = 0.896–0.988). All MEPs recovered after removing IOHFT.

Conclusion

Neurophysiologic events due to IOHFT were common, with the majority in patients with NMS. A shorter stature was a risk factor, and larger Cobb angle and stiffer curve were associated with IOHFT-events. Events occurred at any stage of surgery and involved upper and lower limbs. With an adequate response on IOHFT events, none of the patients had postoperative neurological impairments due to IOHFT.
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Metadata
Title
Risk factors for neurophysiological events related to intraoperative halo-femoral traction in spinal deformity surgery
Authors
Hanneke I. Berends
Agnita Stadhouder
Barend J. van Royen
Henricus L. Journée
Alida A. Gouw
Publication date
05-04-2024
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-024-08221-w