J Alex Sielatycki1, Meghan Cerpa2, Griffin Baum1, Martin Pham1, Earl Thuet1, Ronald A Lehman1, Lawrence G Lenke1. 1. The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, The Spine Hospital, New York Presbyterian, Allen, 5141 Broadway, New York, NY, 10034, USA. 2. The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, The Spine Hospital, New York Presbyterian, Allen, 5141 Broadway, New York, NY, 10034, USA. mc4338@cumc.columbia.edu.
Abstract
STUDY DESIGN: Retrospective cohort. We present a simple classification system that is able to identify patients with increased odds of losing intraoperative neuromonitoring data during thoracic deformity correction. Type 3 spinal cords, with the cord deformed against the concave pedicle in the axial plane, have ×28 greater odds of losing monitoring data during surgery. OBJECTIVES: Assess preoperative morphology of the spinal cord across the thoracic concavity to predict intraoperative loss of neuromonitoring data. METHODS: 128 consecutive patients undergoing surgical correction of a thoracic deformity with pedicle screw/rod constructs were included. Spinal cords were classified into 3 types based on the appearance of the cord on the axial-T2 MRI at the apex of the curve. Type 1 is defined as a circular/symmetric cord with visible CSF between the cord and the apical concave pedicle/vertebral body. Type 2 is a circular/oval/symmetric cord with no visible CSF between the concave pedicle and the cord. Type 3 is a spinal cord that is flattened/deformed by the apical concave pedicle or vertebral body, with no intervening CSF (Fig. 1). RESULTS: 128 patients were reviewed: 81 (63%) Type 1; 32 (25%) Type 2; and 12 (11.7%) Type 3 spinal cords. Lower extremity trans-cranial motor-evoked Potentials (MEPs) and/or somatosensory evoked potentials (SSEPs) were lost intraoperatively in 21 (16%) cases, with full recovery of data in 20 of those cases. On regression analysis, a Type 1 cord was protective against intraoperative data loss (OR = 0.17, p = 0.0003). Type 2 cords had no association with data loss (OR = 0.66, p = 0.49). Type 3 cords had significantly higher odds of intraoperative data loss (OR = 28.3, p < 0.0001). CONCLUSIONS: We present a new spinal cord risk classification scheme to identify patients with increased odds of losing spinal cord monitoring data with thoracic deformity correction. The odds of losing intraoperative MEPs/SSEPs are greater in type 3 spinal cords. LEVEL OF EVIDENCE: III.
STUDY DESIGN: Retrospective cohort. We present a simple classification system that is able to identify patients with increased odds of losing intraoperative neuromonitoring data during thoracic deformity correction. Type 3 spinal cords, with the cord deformed against the concave pedicle in the axial plane, have ×28 greater odds of losing monitoring data during surgery. OBJECTIVES: Assess preoperative morphology of the spinal cord across the thoracic concavity to predict intraoperative loss of neuromonitoring data. METHODS: 128 consecutive patients undergoing surgical correction of a thoracic deformity with pedicle screw/rod constructs were included. Spinal cords were classified into 3 types based on the appearance of the cord on the axial-T2 MRI at the apex of the curve. Type 1 is defined as a circular/symmetric cord with visible CSF between the cord and the apical concave pedicle/vertebral body. Type 2 is a circular/oval/symmetric cord with no visible CSF between the concave pedicle and the cord. Type 3 is a spinal cord that is flattened/deformed by the apical concave pedicle or vertebral body, with no intervening CSF (Fig. 1). RESULTS: 128 patients were reviewed: 81 (63%) Type 1; 32 (25%) Type 2; and 12 (11.7%) Type 3 spinal cords. Lower extremity trans-cranial motor-evoked Potentials (MEPs) and/or somatosensory evoked potentials (SSEPs) were lost intraoperatively in 21 (16%) cases, with full recovery of data in 20 of those cases. On regression analysis, a Type 1 cord was protective against intraoperative data loss (OR = 0.17, p = 0.0003). Type 2 cords had no association with data loss (OR = 0.66, p = 0.49). Type 3 cords had significantly higher odds of intraoperative data loss (OR = 28.3, p < 0.0001). CONCLUSIONS: We present a new spinal cord risk classification scheme to identify patients with increased odds of losing spinal cord monitoring data with thoracic deformity correction. The odds of losing intraoperative MEPs/SSEPs are greater in type 3 spinal cords. LEVEL OF EVIDENCE: III.
Authors: Rajiv R Iyer; Michael G Vitale; Adam N Fano; Hiroko Matsumoto; Daniel J Sucato; Amer F Samdani; Justin S Smith; Munish C Gupta; Michael P Kelly; Han Jo Kim; Daniel M Sciubba; Samuel K Cho; David W Polly; Oheneba Boachie-Adjei; Peter D Angevine; Stephen J Lewis; Lawrence G Lenke Journal: Spine Deform Date: 2022-02-23
Authors: Lawrence G Lenke; Adam N Fano; Rajiv R Iyer; Hiroko Matsumoto; Daniel J Sucato; Amer F Samdani; Justin S Smith; Munish C Gupta; Michael P Kelly; Han Jo Kim; Daniel M Sciubba; Samuel K Cho; David W Polly; Oheneba Boachie-Adjei; Stephen J Lewis; Peter D Angevine; Michael G Vitale Journal: Spine Deform Date: 2022-03-15
Authors: Alejandro Quinonez; Joshua M Pahys; Amer F Samdani; Steven W Hwang; Patrick J Cahill; Randal R Betz Journal: Spinal Cord Ser Cases Date: 2021-04-20