Comparison of multimodal intraoperative neurophysiological monitoring eficacy in early childhood and school aged children undergoing spinal surgery

Abstract

Objective: The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age.Methods: 43 children, diagnosed with spinal pathologies were divided into two cohorts according totheir age and enrolled in the study. Those under the age of 6 consisted group A, whereas those betweenthe age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according totheir diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evokedpotentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded andevaluated at speciŞc time points for each patient.Results: Except for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There wasno false-negative whereas 9 false positive recordings due to physiological conditions that all recoveredintraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosiscomponent. The tcMEPs fully recovered by the end of the operation except for the patient with posttuberculosis kyphosis. There was no statistically signiŞcant difference in the mean threshold values withregard to transcranial stimulus intensity for the tcMEPs between the two groups.Conclusion: Compared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM iseffective for early childhood patients undergoing spinal surgery.Level of evidence: Level III, Diagnostic Study.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)