Abstract：
METHODS: Systematic literature review and meta-analysis.
OBJECTIVE: Predicting patient risk of intraoperative neuromonitoring (IONM) alerts preoperatively can aid patient counselling and surgical planning. Sielatycki et al established an axial-MRI-based spinal cord classification system to predict risk of IONM alerts in scoliosis correction surgery. We aim to systematically review the literature on operative and radiologic factors associated with IONM alerts, including a novel spinal cord classification.
METHODS: A systematic review and meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A literature search identifying all observational studies comparing patients with and without IONM alerts was conducted. Suitable studies were included. Patient demographics, radiological measures and operative factors were collected.
RESULTS: 11 studies were included including 3040 patients. Relative to type 3 cords, type 1 (OR = .03, CI = .01-.08, P < .00001), type 2 (OR = .08, CI = .03, P <.00001) and all non-type 3 cords (OR = .05, CI = .02-.16, P < .00001) were associated with significantly lower odds of IONM alerts. Significant radiographic measures for IONM alerts included coronal Cobb angle (MD = 10.66, CI = 5.77-15.56, P < .00001), sagittal Cobb angle (MD = 9.27, CI = 3.28-14.73, P = .0009), sagittal deformity angle ratio (SDAR) (MD = 2.76, CI = 1.57-3.96, P < .00001) and total deformity angle ratio (TDAR) (MD = 3.44, CI = 2.27-4.462, P < .00001). Clinically, estimated blood loss (MD = 274.13, CI = -240.03-788.28, P = .30), operation duration (MD = 50.79, CI = 20.58-81.00, P = .0010), number of levels fused (MD = .92, CI = .43-1.41, P = .0002) and number of vertebral levels resected (MD = .43, CI = .01-.84, P = .05) were significantly greater in IONM alert patients.
CONCLUSIONS: This study highlights the relationship of operative and radiologic factors with IONM alerts.
OBJECTIVE: Predicting patient risk of intraoperative neuromonitoring (IONM) alerts preoperatively can aid patient counselling and surgical planning. Sielatycki et al established an axial-MRI-based spinal cord classification system to predict risk of IONM alerts in scoliosis correction surgery. We aim to systematically review the literature on operative and radiologic factors associated with IONM alerts, including a novel spinal cord classification.
METHODS: A systematic review and meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A literature search identifying all observational studies comparing patients with and without IONM alerts was conducted. Suitable studies were included. Patient demographics, radiological measures and operative factors were collected.
RESULTS: 11 studies were included including 3040 patients. Relative to type 3 cords, type 1 (OR = .03, CI = .01-.08, P < .00001), type 2 (OR = .08, CI = .03, P <.00001) and all non-type 3 cords (OR = .05, CI = .02-.16, P < .00001) were associated with significantly lower odds of IONM alerts. Significant radiographic measures for IONM alerts included coronal Cobb angle (MD = 10.66, CI = 5.77-15.56, P < .00001), sagittal Cobb angle (MD = 9.27, CI = 3.28-14.73, P = .0009), sagittal deformity angle ratio (SDAR) (MD = 2.76, CI = 1.57-3.96, P < .00001) and total deformity angle ratio (TDAR) (MD = 3.44, CI = 2.27-4.462, P < .00001). Clinically, estimated blood loss (MD = 274.13, CI = -240.03-788.28, P = .30), operation duration (MD = 50.79, CI = 20.58-81.00, P = .0010), number of levels fused (MD = .92, CI = .43-1.41, P = .0002) and number of vertebral levels resected (MD = .43, CI = .01-.84, P = .05) were significantly greater in IONM alert patients.
CONCLUSIONS: This study highlights the relationship of operative and radiologic factors with IONM alerts.
摘要：
方法：系统文献综述和荟萃分析。
目的：术前预测患者术中神经监测（IONM）警报的风险可以帮助患者咨询和手术计划。Sielatycki等人建立了基于轴向MRI的脊髓分类系统，以预测脊柱侧凸矫正手术中IONM警报的风险。我们旨在系统地回顾与IONM警报相关的手术和放射学因素的文献。包括一个新的脊髓分类。
方法：根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行系统评价和荟萃分析。进行了文献检索，确定了所有观察性研究，比较了有和没有IONM警报的患者。包括合适的研究。患者人口统计学，收集放射学措施和手术因素。
结果：纳入11项研究，包括3040例患者。相对于类型3帘线，类型1（OR=.03，CI=.01-.08，P<.00001），类型2（OR=.08，CI=.03，P<.00001）和所有非类型3（OR=.05，CI=.02-.16，P<.00001）与IONM警报的几率显着降低相关。IONM警报的重要射线照相措施包括冠状Cobb角（MD=10.66，CI=5.77-15.56，P<.00001），矢状Cobb角（MD=9.27，CI=3.28-14.73，P=.0009），矢状畸形角比(SDAR)(MD=2.76,CI=1.57~3.96,P<.00001)和总畸形角比(TDAR)(MD=3.44,CI=2.27~4.462,P<.00001)。临床上,估计失血量（MD=274.13，CI=-240.03-788.28，P=.30），手术持续时间（MD=50.79，CI=20.58-81.00，P=.0010），融合水平数（MD=.92，CI=.43-1.41，P=.0002）和切除的椎体水平数（MD=.43，CI=.01-.84，P=.05）在IONM警报患者中显著增加。
结论：本研究强调了手术和放射学因素与IONM警报的关系。
目的：术前预测患者术中神经监测（IONM）警报的风险可以帮助患者咨询和手术计划。Sielatycki等人建立了基于轴向MRI的脊髓分类系统，以预测脊柱侧凸矫正手术中IONM警报的风险。我们旨在系统地回顾与IONM警报相关的手术和放射学因素的文献。包括一个新的脊髓分类。
方法：根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行系统评价和荟萃分析。进行了文献检索，确定了所有观察性研究，比较了有和没有IONM警报的患者。包括合适的研究。患者人口统计学，收集放射学措施和手术因素。
结果：纳入11项研究，包括3040例患者。相对于类型3帘线，类型1（OR=.03，CI=.01-.08，P<.00001），类型2（OR=.08，CI=.03，P<.00001）和所有非类型3（OR=.05，CI=.02-.16，P<.00001）与IONM警报的几率显着降低相关。IONM警报的重要射线照相措施包括冠状Cobb角（MD=10.66，CI=5.77-15.56，P<.00001），矢状Cobb角（MD=9.27，CI=3.28-14.73，P=.0009），矢状畸形角比(SDAR)(MD=2.76,CI=1.57~3.96,P<.00001)和总畸形角比(TDAR)(MD=3.44,CI=2.27~4.462,P<.00001)。临床上,估计失血量（MD=274.13，CI=-240.03-788.28，P=.30），手术持续时间（MD=50.79，CI=20.58-81.00，P=.0010），融合水平数（MD=.92，CI=.43-1.41，P=.0002）和切除的椎体水平数（MD=.43，CI=.01-.84，P=.05）在IONM警报患者中显著增加。
结论：本研究强调了手术和放射学因素与IONM警报的关系。
