Intraoperative Neurophysiological Monitoring in Corrective Surgery of Scoliosis – Experience at a Tertiary Care Hospital

Abstract

Objective: To evaluate the role of intraoperative neurophysiological monitoring (IONM) in reducing the postoperative neurologic deficit following corrective surgery of scoliosis. Study Design: Observational Study. Place and Duration of the Study: Spine Surgery Department, Combined Military Hospital, Rawalpindi, from December 2022 to May 2023. Methodology: The study included 170 cases of scoliosis operated under multimodal IONM. Decreased amplitude of ≥50% in SSEP or 70-80% in MEPs were considered warning signs. Cases were divided into two groups: Group 1 (signal drop) and Group 2 (no signal drop). Group 1 was subdivided into Group 1a (true positive), Group 1b (false positive) and Group 1c (intermediate positive). Group 2 was subdivided into Group 2a (true negative) and Group 2b (false negative). Results: Evoked potential changes were observed in 27 (15.9%) cases. This includes transient drop of signals in 16 (9.4%) and sustained drop of signals in 11 (6.5%) cases. Among sustained signal drop, 9 (5.29%) cases had exhibited postoperative neurological deficit whereas 2 (1.17%) cases did not show postoperative neurological deficit (false positive). Multimodal IONM in the current study shows sensitivity of 100%, specificity of 98.6%, positive predictive value of 92.6%, and negative predictive value of 100%. Conclusion: Multimodal IONM reduces the incidence of postoperative neurological deficit in corrective surgery of scoliosis by effectively detecting neurologic injury during surgery. Monitoring events alert surgical team to exercise immediate corrective measures which likely results in recovery of lost signals and predict the favorable outcome.