Martine Gavaret1,2, Sébastien Pesenti3,4, Elie Choufani3,4, Daniela Pennaroli5, Gérard Bollini3,4, Jean-Luc Jouve3,4. 1. AP-HM, Service de Neurophysiologie Clinique, Hôpital de la Timone, 264 rue Saint Pierre, 13005, Marseille, France. martine.gavaret@ap-hm.fr. 2. Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France. martine.gavaret@ap-hm.fr. 3. Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France. 4. AP-HM, Service d'orthopédie pédiatrique, Hôpital Timone Enfants, 264 rue St Pierre, 13005, Marseille, France. 5. AP-HM, Service de Neurophysiologie Clinique, Hôpital de la Timone, 264 rue Saint Pierre, 13005, Marseille, France.
Abstract
PURPOSE: The purpose was to study intraoperative spinal cord monitoring (IOM) particularities and performances in children under 4 years old with congenital spinal deformities. IOM is characterized by specific difficulties due to the immaturity of sensory-motor pathways in such young patients. To the best of our knowledge, this study is the largest dedicated to IOM in this challenging population. METHODS: This study was retrospective and monocentric. 78 IOM in children under 4 years old were analyzed. Somatosensory evoked potentials (SSEP), neurogenic mixed evoked potentials (NMEP) and D waves were performed. Patients were classified into one of four categories with respect to IOM data and clinical outcome: true positive, false positive, true negative and false negative. Sensitivity and specificity were then calculated accordingly. RESULTS: There were 6 true positive, 3 false positive, 67 true negative and 1 false negative outcomes. One patient was characterized by unreliable baseline IOM data. IOM sensitivity was 86 %. IOM specificity was 96 %. The false negative case was monitored using SSEP alone. IOM was difficult in 10/77 cases, being unilateral because of a planned fibular graft harvest. NMEP were characterized by higher signal-to-noise ratio than SSEP. CONCLUSIONS: Immaturity of sensory-motor pathways predominates in the central rather than the peripheral nervous system in young children. MEP and D waves could thus be difficult to obtain. Although non-specific to motor pathways, it could be useful to "by-pass" the brain, using NMEP. In regard to maturational particularities, IOM in children under 4 years old should be performed by experienced neurophysiologists, avoiding in these cases surgeon-guided devices.
PURPOSE: The purpose was to study intraoperative spinal cord monitoring (IOM) particularities and performances in children under 4 years old with congenital spinal deformities. IOM is characterized by specific difficulties due to the immaturity of sensory-motor pathways in such young patients. To the best of our knowledge, this study is the largest dedicated to IOM in this challenging population. METHODS: This study was retrospective and monocentric. 78 IOM in children under 4 years old were analyzed. Somatosensory evoked potentials (SSEP), neurogenic mixed evoked potentials (NMEP) and D waves were performed. Patients were classified into one of four categories with respect to IOM data and clinical outcome: true positive, false positive, true negative and false negative. Sensitivity and specificity were then calculated accordingly. RESULTS: There were 6 true positive, 3 false positive, 67 true negative and 1 false negative outcomes. One patient was characterized by unreliable baseline IOM data. IOM sensitivity was 86 %. IOM specificity was 96 %. The false negative case was monitored using SSEP alone. IOM was difficult in 10/77 cases, being unilateral because of a planned fibular graft harvest. NMEP were characterized by higher signal-to-noise ratio than SSEP. CONCLUSIONS: Immaturity of sensory-motor pathways predominates in the central rather than the peripheral nervous system in young children. MEP and D waves could thus be difficult to obtain. Although non-specific to motor pathways, it could be useful to "by-pass" the brain, using NMEP. In regard to maturational particularities, IOM in children under 4 years old should be performed by experienced neurophysiologists, avoiding in these cases surgeon-guided devices.
Authors: M Gavaret; J L Jouve; Y Péréon; F Accadbled; N André-Obadia; E Azabou; B Blondel; G Bollini; J Delécrin; J-P Farcy; J Fournet-Fayard; C Garin; P Henry; V Manel; V Mutschler; G Perrin; J Sales de Gauzy Journal: Orthop Traumatol Surg Res Date: 2013-08-23 Impact factor: 2.256
Authors: James Drake; Reinhard Zeller; Abhaya V Kulkarni; Samuel Strantzas; Laura Holmes Journal: Childs Nerv Syst Date: 2010-03-07 Impact factor: 1.475
Authors: Gene Cheh; Lawrence G Lenke; Anne M Padberg; Yongjung J Kim; Michael D Daubs; Craig Kuhns; Georgia Stobbs; Marsha Hensley Journal: Spine (Phila Pa 1976) Date: 2008-05-01 Impact factor: 3.468
Authors: Franz J Frei; Sven E Ryhult; Ewald Duitmann; Carol C Hasler; Juerg Luetschg; Thomas O Erb Journal: Spine (Phila Pa 1976) Date: 2007-04-15 Impact factor: 3.468