Abstract：
METHODS: Retrospective cohort study.
OBJECTIVE: To elucidate the risk factors of intraoperative neurophysiological monitoring (IONM) alert during deformity correction surgery for adolescent idiopathic scoliosis (AIS) and to describe the outcomes of patients who underwent staged correction surgery due to IONM alert during the initial procedure.
METHODS: We reviewed 1 024 patients with idiopathic scoliosis who underwent deformity correction and were followed-up for ≥1 year. The pre-and postoperative Cobb angle of the major structural curve, operative time, estimated blood loss (EBL), number of levels fused, event that caused the IONM alert, and intervention required for the recovery of the signal were recorded. Patients who received IONM alerts (alert group) and those who did not (non-alert group) during the operation were compared.
RESULTS: Compared to the non-alert group, the alert group had a significantly greater preoperative Cobb angle of the major structural curve (P < .001), number of levels fused (P = .003), operative time (P < .001), and EBL (P < .001). The percentage of correction did not significantly differ between the 2 groups (P = .348). Eight patients (.8%) underwent a staged operation because the IONM signal alert hindered correction of the deformity. The percentage of correction of patients who underwent staged operation was 64.9 ± 15.1%, and no permanent neurologic deficits occurred.
CONCLUSIONS: A greater magnitude of preoperative deformity and surgical extent increases the risk of cord injury identified by IONM alerts during correction of deformities in patients with AIS. However, in patients in whom the IONM alert cannot be recovered or reproduced by proceeding with deformity correction, surgeons can minimize the risk by aborting the initial procedure and completing the correction using staged operations.
OBJECTIVE: To elucidate the risk factors of intraoperative neurophysiological monitoring (IONM) alert during deformity correction surgery for adolescent idiopathic scoliosis (AIS) and to describe the outcomes of patients who underwent staged correction surgery due to IONM alert during the initial procedure.
METHODS: We reviewed 1 024 patients with idiopathic scoliosis who underwent deformity correction and were followed-up for ≥1 year. The pre-and postoperative Cobb angle of the major structural curve, operative time, estimated blood loss (EBL), number of levels fused, event that caused the IONM alert, and intervention required for the recovery of the signal were recorded. Patients who received IONM alerts (alert group) and those who did not (non-alert group) during the operation were compared.
RESULTS: Compared to the non-alert group, the alert group had a significantly greater preoperative Cobb angle of the major structural curve (P < .001), number of levels fused (P = .003), operative time (P < .001), and EBL (P < .001). The percentage of correction did not significantly differ between the 2 groups (P = .348). Eight patients (.8%) underwent a staged operation because the IONM signal alert hindered correction of the deformity. The percentage of correction of patients who underwent staged operation was 64.9 ± 15.1%, and no permanent neurologic deficits occurred.
CONCLUSIONS: A greater magnitude of preoperative deformity and surgical extent increases the risk of cord injury identified by IONM alerts during correction of deformities in patients with AIS. However, in patients in whom the IONM alert cannot be recovered or reproduced by proceeding with deformity correction, surgeons can minimize the risk by aborting the initial procedure and completing the correction using staged operations.
摘要：
方法：回顾性队列研究。
目的：阐明青少年特发性脊柱侧凸(AIS)畸形矫正手术期间术中神经生理监测(IONM)警报的危险因素，并描述初始手术期间因IONM警报而接受分期矫正手术的患者的预后。
方法：我们对1024例特发性脊柱侧凸患者进行了畸形矫正，随访时间≥1年。术前、术后主要结构曲线的Cobb角,手术时间,估计失血量（EBL），融合的级别数，导致IONM警报的事件，并记录信号恢复所需的干预措施。比较在手术期间接受IONM警报的患者（警报组）和未接受IONM警报的患者（非警报组）。
结果：与非警戒组相比，警戒组术前主要结构曲线的Cobb角明显更大（P<.001），融合的水平数（P=.003），手术时间(P<.001),和EBL（P<.001）。两组之间的校正百分比没有显着差异（P=.348）。八名患者（.8％）接受了分期手术，因为IONM信号警报阻碍了畸形的矫正。分期手术患者的矫正率为64.9±15.1%，并且没有发生永久性的神经缺陷。
结论：术前畸形和手术程度较大会增加AIS患者在矫正畸形期间通过IONM警报确定的脊髓损伤的风险。然而,在无法通过进行畸形矫正来恢复或再现IONM警报的患者中，外科医生可以通过中止初始手术并使用分阶段手术完成矫正来将风险降至最低。
目的：阐明青少年特发性脊柱侧凸(AIS)畸形矫正手术期间术中神经生理监测(IONM)警报的危险因素，并描述初始手术期间因IONM警报而接受分期矫正手术的患者的预后。
方法：我们对1024例特发性脊柱侧凸患者进行了畸形矫正，随访时间≥1年。术前、术后主要结构曲线的Cobb角,手术时间,估计失血量（EBL），融合的级别数，导致IONM警报的事件，并记录信号恢复所需的干预措施。比较在手术期间接受IONM警报的患者（警报组）和未接受IONM警报的患者（非警报组）。
结果：与非警戒组相比，警戒组术前主要结构曲线的Cobb角明显更大（P<.001），融合的水平数（P=.003），手术时间(P<.001),和EBL（P<.001）。两组之间的校正百分比没有显着差异（P=.348）。八名患者（.8％）接受了分期手术，因为IONM信号警报阻碍了畸形的矫正。分期手术患者的矫正率为64.9±15.1%，并且没有发生永久性的神经缺陷。
结论：术前畸形和手术程度较大会增加AIS患者在矫正畸形期间通过IONM警报确定的脊髓损伤的风险。然而,在无法通过进行畸形矫正来恢复或再现IONM警报的患者中，外科医生可以通过中止初始手术并使用分阶段手术完成矫正来将风险降至最低。
