Diagnostic Accuracy of Somatosensory Evoked Potential monitoring during Scoliosis correction surgery in the pediatric population: A Systematic Review
Vamsi Krishna Gorijala1, Likhita Shaik4, Parthasarathy Thirumala2, Katherine Anetakis2, Jeffery Balzer2, Donald Crammond2, Varun Shandal2, Joon Y Lee3, Jeremy Shaw3, Rajiv Reddy3
1Neurological Surgery, 2Neurological Surgery, Neurology, 3Pittsburgh Orthopedic Spine Research, University of Pittsburgh Medical Center, 4Hennepin Healthcare
Objective:
To evaluate the diagnostic accuracy of intraoperative somatosensory evoked potential (SSEP) monitoring in predicting the risk of perioperative neurological outcomes during scoliosis fusion surgery for idiopathic scoliosis (IS) in the pediatric age group (≤ 21 years).
Background:
Scoliosis correction surgery is the most effective treatment for pediatric IS. However, new neurological deficits during the surgery can potentially affect the outcomes of this surgery. Intraoperative neuromonitoring techniques like SSEP provide real-time information about the spinal cord and nerve roots and can be used as a reliable indicator to predict perioperative neurological deficits.
Design/Methods:
A systematic review of various databases to find literature on pediatric IS patients who underwent scoliosis correction with intraoperative neuromonitoring. Data collection included study design, patient demographics, procedure, neuromonitoring modalities, SSEP alarm criteria, SSEP changes (including reversible and irreversible changes), and perioperative neurological deficit. We calculated the sensitivity, specificity, and diagnostic odds ratio (DOR) of SSEP changes (total, transient, and persistent) and SSEP loss for predicting perioperative neurological deficits.
Results:
We included eighteen studies for our final analysis, with a total cohort of 4674 children. The incidence of a significant SSEP change was 3.1% (145/4674), while the incidence of a new neurological deficit was 1.01% (47/4674). The incidence of new neurological deficits in children with an intraoperative SSEP change was 28.28% (41/145), while it was 0.13% (6/4529) in children without an SSEP change.
SSEP changes had a sensitivity of 72%, specificity of 97%, and DOR of 98.64, while SSEP loss had a sensitivity of 42%, specificity of 99.3%, and a DOR of 143.76 for predicting new neurologic deficit. Transient and Persistent SSEP changes had sensitivities of 37% and 39%, specificities of 97% and 99.2%, and DORs of 18.09 and 75.43, respectively.
Conclusions:
Intraoperative SSEP monitoring can predict perioperative neurological injury and help improve the surgical outcomes in pediatric scoliosis fusion surgery.