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29-01-2024 | Somatosensory Evoked Potential | Review Article

Diagnostic utility of different types of somatosensory evoked potential changes in pediatric idiopathic scoliosis correction surgery

Authors: Vamsi Krishna Gorijala, Rajiv P. Reddy, Katherine M. Anetakis, Jeffrey Balzer, Donald J. Crammond, Varun Shandal, Jeremy D. Shaw, Michelle R. Christie, Parthasarathy D. Thirumala

Published in: European Spine Journal | Issue 4/2024

Abstract

Purpose

To evaluate the diagnostic accuracy of intraoperative somatosensory evoked potential (SSEP) monitoring and types of SSEP changes in predicting the risk of postoperative neurological outcomes during correction surgery for idiopathic scoliosis (IS) in the pediatric age group (≤ 21 years).

Methods

Database review was performed to identify literature on pediatric patients with IS who underwent correction with intraoperative neuromonitoring. The sensitivity, specificity, and diagnostic odds ratio (DOR) of transient and persistent SSEP changes and complete SSEP loss in predicting postoperative neurological deficits were calculated.

Results

Final analysis included 3778 patients. SSEP changes had a sensitivity of 72.9%, specificity of 96.8%, and DOR of 102.3, while SSEP loss had a sensitivity of 41.8%, specificity of 99.3%, and DOR of 133.2 for predicting new neurologic deficits. Transient and persistent SSEP changes had specificities of 96.8% and 99.1%, and DORs of 16.6 and 59, respectively.

Conclusion

Intraoperative SSEP monitoring can predict perioperative neurological injury and improve surgical outcomes in pediatric scoliosis fusion surgery.

Level of evidence: Level 2. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Roach JW (1999) Adolescent idiopathic scoliosis. Orthop Clin North Am 30(353–365):vii. https://doi.org/10.1016/s0030-5898(05)70092-4CrossRef

Asher MA, Burton DC (2006) Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis 1:2. https://doi.org/10.1186/1748-7161-1-2CrossRefPubMedPubMedCentral

Adobor RD, Joranger P, Steen H, Navrud S, Brox JI (2014) A health economic evaluation of screening and treatment in patients with adolescent idiopathic scoliosis. Scoliosis 9:21. https://doi.org/10.1186/s13013-014-0021-8CrossRefPubMedPubMedCentral

Hamilton DK, Smith JS, Sansur CA, Glassman SD, Ames CP, Berven SH, Polly DW, Perra JH, Knapp DR, Boachie-Adjei O, McCarthy RE, Shaffrey CI, Morbidity SRS, Committee M (2011) Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine (Phila Pa 1976) 36:1218–1228. https://doi.org/10.1097/BRS.0b013e3181ec5fd9

Tsai S-W, Tsai C-L, Wu P-T, Wu C-Y, Liu C-L, Jou I-M (2012) Intraoperative use of somatosensory-evoked potential in monitoring nerve roots. J Clin Neurophysiol 29:110–117. https://doi.org/10.1097/WNP.0b013e31824cecd3CrossRefPubMed

MacDonald DB, Dong C, Quatrale R, Sala F, Skinner S, Soto F, Szelényi A (2019) Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials. Clin Neurophysiol 130:161–179. https://doi.org/10.1016/j.clinph.2018.10.008CrossRefPubMed

Thirumala PD, Bodily L, Tint D, Ward WT, Deeney VF, Crammond DJ, Habeych ME, Balzer JR (2014) Somatosensory-evoked potential monitoring during instrumented scoliosis corrective procedures: validity revisited. Spine J 14:1572–1580. https://doi.org/10.1016/j.spinee.2013.09.035CrossRefPubMed

Melachuri SR, Kaur J, Melachuri MK, Ninaci D, Crammond DJ, Balzer JR, Thirumala PD (2019) The diagnostic accuracy of somatosensory evoked potentials in evaluating neurological deficits during 1057 lumbar interbody fusions. J Clin Neurosci 61:78–83. https://doi.org/10.1016/j.jocn.2018.10.140CrossRefPubMed

Melachuri SR, Stopera C, Melachuri MK, Anetakis K, Crammond DJ, Castellano JF, Balzer JR, Thirumala PD (2020) The efficacy of somatosensory evoked potentials in evaluating new neurological deficits after spinal thoracic fusion and decompression. J Neurosurg Spine 1–6. https://doi.org/10.3171/2019.12.SPINE191157

10.

Chang R, Reddy RP, Coutinho D v, Chang Y-F, Anetakis KM, Crammond DJ, Balzer JR, Thirumala PD (2021) Diagnostic Accuracy of Changes During Lumbar Spine Surgery for Predicting Postoperative Neurological Deficit: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 46:E1343–E1352. https://doi.org/10.1097/BRS.0000000000004099

11.

Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE (1995) Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 96:6–11CrossRefPubMed

12.

Thirumala PD, Cheng HL, Loke YK, Kojo Hamilton D, Balzer J, Crammond DJ (2016) Diagnostic accuracy of somatosensory evoked potential monitoring during scoliosis fusion. J Clin Neurosci 30:8–14. https://doi.org/10.1016/j.jocn.2016.01.017CrossRefPubMed

13.

Toleikis JR, of Neurophysiological Monitoring AS, (2005) Intraoperative monitoring using somatosensory evoked potentials. A position statement by the American Society of Neurophysiological Monitoring. J Clin Monit Comput 19:241–258. https://doi.org/10.1007/s10877-005-4397-0CrossRefPubMed

14.

Banoub M, Tetzlaff JE, Schubert A (2003) Pharmacologic and physiologic influences affecting sensory evoked potentials. Anesthesiology 99:716–737. https://doi.org/10.1097/00000542-200309000-00029CrossRefPubMed

15.

(1994) Guideline eleven: guidelines for intraoperative monitoring of sensory evoked potentials. American Electroencephalographic Society. Journal of Clinical Neurophysiology 11:77–87

16.

Doebler P, Holling H, Sousa-Pinto B (2017) Meta-Analysis of Diagnostic Accuracy with mada. https://rdrr.io/rforge/mada/r-forge.r-project.org/projects/mada/

17.

Whiting PF, Rutges AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MMG, Sterne JAC, Bossuyt PMM (2011) QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536. https://doi.org/10.7326/0003-4819-155-8-201110180-00009CrossRefPubMed

18.

Padberg AM, Wilson-Holden TJ, Lenke LG, Bridwell KH (1998) Somatosensory- and motor-evoked potential monitoring without a wake-up test during idiopathic scoliosis surgery. Spine (Phila Pa 1976) 23:1392–1400. https://doi.org/10.1097/00007632-199806150-00018

19.

Luk KDK, Hu Y, Wong YW, Leong JCY (1999) Variability of Somatosensory-Evoked Potentials in Different Stages of Scoliosis Surgery. Spine (Phila Pa 1976) 24:1799. https://doi.org/10.1097/00007632-199909010-00009

20.

Noonan KJ, Walker T, Feinberg JR, Nagel M, Didelot W, Lindseth R (2002) Factors Related to False-Versus True-Positive Neuromonitoring Changes in Adolescent Idiopathic Scoliosis Surgery. Spine (Phila Pa 1976) 27:825–830. https://doi.org/10.1097/00007632-200204150-00009

21.

MacDonald DB, Al Zayed Z, Khoudeir I, Stigsby B (2003) Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine (Phila Pa 1976) 28:194–203. https://doi.org/10.1097/00007632-200301150-00018

22.

Schwartz DM, Auerbach JD, Dormans JP, Flynn J, Drummond DS, Bowe JA, Laufer S, Shah SA, Bowen JR, Pizzutillo PD, Jones KJ, Drummond DS (2007) Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg 89:2440–2449. https://doi.org/10.2106/JBJS.F.01476CrossRefPubMed

23.

Kundnani VK, Zhu L, Tak HH, Wong HK (2010) Multimodal intraoperative neuromonitoring in corrective surgery for adolescent idiopathic scoliosis: evaluation of 354 consecutive cases. Indian J Orthop 44:64–72. https://doi.org/10.4103/0019-5413.58608CrossRefPubMedPubMedCentral

24.

Lewis SJ, Gray R, Holmes LM, Strantzas S, Jhaveri S, Zaarour C, Magana S (2011) Neurophysiological changes in deformity correction of adolescent idiopathic scoliosis with intraoperative skull-femoral traction. Spine (Phila Pa 1976) 36:1627–1638. https://doi.org/10.1097/BRS.0b013e318216124e

25.

Shah SA, Dhawale AA, Oda JE, Yorgova P, Neiss GI, Holmes L, Gabos PG (2013) Ponte osteotomies with pedicle screw instrumentation in the treatment of adolescent idiopathic scoliosis. Spine Deform 1:196–204. https://doi.org/10.1016/j.jspd.2013.03.002CrossRefPubMed

26.

Huang S-L, Qi H-G, Liu J-J, Li J-L, Huang Y-J, Xiang L (2016) Alarm value of somatosensory evoked potential in idiopathic scoliosis surgery. World Neurosurg 92:397–401. https://doi.org/10.1016/j.wneu.2016.05.054CrossRefPubMed

27.

Krishnakumar R, Srivatsa N (2017) Multimodal intraoperative neuromonitoring in scoliosis surgery: a two-year prospective analysis in a single centre. Neurol India 65:75–79. https://doi.org/10.4103/0028-3886.198189CrossRefPubMed

28.

Kwan MK, Chiu CK, Hasan MS, Tan SH, Loh LH, Yeo KS, Lee WH, Chan CYW (2019) Perioperative Outcome of Single Stage Posterior Spinal Fusion for Severe Adolescent Idiopathic Scoliosis (AIS) (Cobb Angle ≥90°). Spine (Phila Pa 1976) 44:E348–E356. https://doi.org/10.1097/BRS.0000000000002848

29.

Chen J, Yang J, Deng Y, Sui W, Shao X, Huang Z, Yang J (2020) a retrospective study of surgical correction for spinal deformity with and without osteotomy to compare outcome using intraoperative neurophysiological monitoring with evoked potentials. Med Sci Monitor 26. https://doi.org/10.12659/MSM.925371

30.

Kato S, Lewis SJ, Sharma O, Chua S, Rabin D, Al-Jahwari A, Bacon S, Gray RJ, Keshen S, Magana S, Zeller RD (2020) Impact of various weights in the intraoperative skull-skeletal traction on correction of adolescent idiopathic scoliosis. Global Spine J 10:1015–1021. https://doi.org/10.1177/2192568219882348CrossRefPubMed

31.

Mihara Y, Chung WH, Chiu CK, Hasan MS, Lee SY, Ch’ng PY, Chan CYW, Kwan MK (2020) Perioperative outcome of severe idiopathic scoliosis (Cobb Angle ≥ 90°). Spine (Phila Pa 1976) 45:381–389. https://doi.org/10.1097/BRS.0000000000003274

32.

Nassef M, Splinter W, Lidster N, Al-Kalbani A, Nashed A, Ilton S, Vanniyasingam T, Paul J (2021) Intraoperative neurophysiologic monitoring in idiopathic scoliosis surgery: a retrospective observational study of new neurologic deficits. Can J Anesthesia 68:477–484. https://doi.org/10.1007/s12630-020-01898-9CrossRef

33.

Lesser RP, Raudzens P, Lüders H, Nuwer MR, Goldie WD, Morris HH, Dinner DS, Klem G, Hahn JF, Shetter AG, Ginsburg HH, Gurd AR (1986) Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials. Ann Neurol 19:22–25. https://doi.org/10.1002/ana.410190105CrossRefPubMed

34.

Chen Z-Y, Wong H-K, Chan Y-H (2004) Variability of somatosensory evoked potential monitoring during scoliosis surgery. J Spinal Disord Tech 17:470–476. https://doi.org/10.1097/01.bsd.0000133465.89618.c8CrossRefPubMed

35.

Seyal M, Mull B (2002) Mechanisms of signal change during intraoperative somatosensory evoked potential monitoring of the spinal cord. J Clin Neurophysiol 19:409–415. https://doi.org/10.1097/00004691-200210000-00004CrossRefPubMed

36.

Astrup J, Blennow G, Nilsson B (1979) Effects of reduced cerebral blood flow upon EEG pattern, cerebral extracellular potassium, and energy metabolism in the rat cortex during bicuculline-induced seizures. Brain Res 177:115–126. https://doi.org/10.1016/0006-8993(79)90922-3CrossRefPubMed

37.

Branston NM, Symon L, Crockard HA, Pasztor E (1974) Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusion in the baboon. Exp Neurol 45:195–208. https://doi.org/10.1016/0014-4886(74)90112-5CrossRefPubMed

38.

Astrup J, Symon L, Branston NM, Lassen NA (1977) Cortical evoked potential and extracellular K+ and H+ at critical levels of brain ischemia. Stroke 8:51–57. https://doi.org/10.1161/01.STR.8.1.51CrossRefPubMed

39.

Lenke LG, Fano AN, Iyer RR, Matsumoto H, Sucato DJ, Samdani AF, Smith JS, Gupta MC, Kelly MP, Kim HJ, Sciubba DM, Cho SK, Polly DW, Boachie-Adjei O, Lewis SJ, Angevine PD, Vitale MG (2022) Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery. Spine Deform 10:745–761. https://doi.org/10.1007/s43390-022-00485-wCrossRefPubMed

40.

Pajewski TN, Arlet V, Phillips LH (2007) Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon. Eur Spine J 16:115–129. https://doi.org/10.1007/s00586-007-0419-6CrossRefPubMedCentral

41.

Thirumala PD, Huang J, Thiagarajan K, Cheng H, Balzer J, Crammond DJ (2016) Diagnostic accuracy of combined multimodality somatosensory evoked potential and transcranial motor evoked potential intraoperative monitoring in patients with idiopathic scoliosis. Spine (Phila Pa 1976) 41:E1177–E1184. https://doi.org/10.1097/BRS.0000000000001678

Title: Diagnostic utility of different types of somatosensory evoked potential changes in pediatric idiopathic scoliosis correction surgery
Authors: Vamsi Krishna Gorijala
Rajiv P. Reddy
Katherine M. Anetakis
Jeffrey Balzer
Donald J. Crammond
Varun Shandal
Jeremy D. Shaw
Michelle R. Christie
Parthasarathy D. Thirumala
Publication date: 29-01-2024
Publisher: Springer Berlin Heidelberg
Keywords: Somatosensory Evoked Potential
Somatosensory Evoked Potential
Idiopathic Scoliosis
Scoliosis
Neuromonitoring
Motor Evoked Potential
Motor Evoked Potential
Published in: European Spine Journal / Issue 4/2024
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-023-08063-y

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Springer Medicine

Diagnostic utility of different types of somatosensory evoked potential changes in pediatric idiopathic scoliosis correction surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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