Abstract：
OBJECTIVE: Use of spinal cord monitoring in children with cerebral palsy (CP) and neuromuscular scoliosis is challenging. The previous reports suggest low success rates in the setting of CP, and it is unclear if transcranial electric motor evoked potentials (TcMEP) monitoring is contraindicated in patients with an active seizure disorder. The purpose of this study was to determine (1) are patients with CP able to be appropriately monitored with TcMEP? and (2) does TcMEP cause an increase in seizure activity?
METHODS: This was an institutional review board-approved retrospective cohort study observing 304 patients from 2011 to 2020. Inclusion criteria included all patients with CP undergoing posterior spinal fusion during this time. Intraoperative data were examined for the ability to obtain monitoring and any intraoperative events. Patients were followed for 3 months postoperatively to determine any increase in seizure activity that could have been attributed to the TcMEP monitoring.
RESULTS: Of the 304 patients who were observed, 21% (20.8%) were unable to be monitored due to lacking baseline signals from the extremities. Seventy-seven percent (77.5%) were successfully monitored with TcMEP. For these patients, no increased seizure activity was documented either intra- or postoperatively.
CONCLUSIONS: A high percentage of children (77.5%) with CP were able to be successfully monitored with TcMEP during posterior spinal fusion. Furthermore, the concerns about increased seizure activity after TcMEP were not supported by the data from this cohort. Technical details of successful neuromonitoring in these patients are important and included increased stimulation voltage requirements and latency times.
METHODS: III retrospective comparative study.
METHODS: This was an institutional review board-approved retrospective cohort study observing 304 patients from 2011 to 2020. Inclusion criteria included all patients with CP undergoing posterior spinal fusion during this time. Intraoperative data were examined for the ability to obtain monitoring and any intraoperative events. Patients were followed for 3 months postoperatively to determine any increase in seizure activity that could have been attributed to the TcMEP monitoring.
RESULTS: Of the 304 patients who were observed, 21% (20.8%) were unable to be monitored due to lacking baseline signals from the extremities. Seventy-seven percent (77.5%) were successfully monitored with TcMEP. For these patients, no increased seizure activity was documented either intra- or postoperatively.
CONCLUSIONS: A high percentage of children (77.5%) with CP were able to be successfully monitored with TcMEP during posterior spinal fusion. Furthermore, the concerns about increased seizure activity after TcMEP were not supported by the data from this cohort. Technical details of successful neuromonitoring in these patients are important and included increased stimulation voltage requirements and latency times.
METHODS: III retrospective comparative study.
摘要：
目的：在患有脑瘫（CP）和神经肌肉脊柱侧凸的儿童中使用脊髓监测具有挑战性。以前的报告显示CP设置的成功率较低，目前尚不清楚活动性癫痫患者是否禁用经颅电动运动诱发电位（TcMEP）监测。这项研究的目的是确定（1）是否可以用TcMEP适当监测CP患者？（2）TcMEP是否会导致癫痫发作活动增加？
方法：这是一项机构审查委员会批准的回顾性队列研究，观察了2011年至2020年的304名患者。纳入标准包括在此期间接受后路脊柱融合术的所有CP患者。检查术中数据以获得监测和任何术中事件的能力。术后随访患者3个月，以确定癫痫发作活动的任何增加，这可能归因于TcMEP监测。
结果：在观察到的304名患者中，21%(20.8%)由于缺乏来自四肢的基线信号而无法监测。用TcMEP成功监测了77%(77.5%)。对于这些患者来说,术中或术后均未记录癫痫发作活动增加.
结论：在后路脊柱融合术过程中，有很高比例的CP患儿（77.5%）能够用TcMEP成功监测。此外，该队列的数据不支持对TcMEP后癫痫发作活动增加的担忧.在这些患者中成功进行神经监测的技术细节很重要，包括增加的刺激电压要求和潜伏期。
方法：III回顾性比较研究。
方法：这是一项机构审查委员会批准的回顾性队列研究，观察了2011年至2020年的304名患者。纳入标准包括在此期间接受后路脊柱融合术的所有CP患者。检查术中数据以获得监测和任何术中事件的能力。术后随访患者3个月，以确定癫痫发作活动的任何增加，这可能归因于TcMEP监测。
结果：在观察到的304名患者中，21%(20.8%)由于缺乏来自四肢的基线信号而无法监测。用TcMEP成功监测了77%(77.5%)。对于这些患者来说,术中或术后均未记录癫痫发作活动增加.
结论：在后路脊柱融合术过程中，有很高比例的CP患儿（77.5%）能够用TcMEP成功监测。此外，该队列的数据不支持对TcMEP后癫痫发作活动增加的担忧.在这些患者中成功进行神经监测的技术细节很重要，包括增加的刺激电压要求和潜伏期。
方法：III回顾性比较研究。
