ArticleSpine deformity2023
Deformity angular ratio is associated with neuromonitoring changes without a vertebral column resection: spinal deformity is more influential than type of surgery.
Article in Spine deformity, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 16 citations in OpenAlex.
- Intraoperative neurophysiological monitoring changes during surgical correction of pediatric neuromuscular scoliosis: a single-institution report.Spine deformity · 2026Article
- Intraoperative neuromonitoring alerts during surgery for congenital spinal deformity: prevalence, risk factors, and outcomes in a prospective study of 100 patients.Spine deformity · 2026Article
- Predictive value of deformity angular ratio (DAR) for intraoperative neuromonitoring (IONM) signal loss and neurological complications in spinal deformity surgery: a systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Review
- Clinical outcomes after surgical treatment of severe congenital spinal deformity in skeletally mature patients: A minimum two-year follow-up study.Journal of orthopaedic surgery and research · 2025Article
- Severe scoliotic deformities: results of surgical treatment and complications in a multicentric series of children and young adults.Spine deformity · 2025Article
- Intraoperative Neurophysiological Monitoring in Patients With Marfan Syndrome Scoliosis.Orthopaedic surgery · 2025Article
- Higher intraoperative blood loss is associated with increased risk of intraoperative neuromonitoring data loss for the type 3 spinal cord shape during spinal deformity surgery.Spine deformity · 2025Article
- A new predictive factor for postoperative neurological deficits in patients with severe post-tuberculous kyphosis: the deformity angular distance ratio.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Deformity angular distance ratio independently predicts intraoperative neuromonitoring alerts in spinal deformity correction.Journal of orthopaedic surgery and research · 2025Article
- Does the coronal deformity angular ratio affect bracing outcome in adolescent idiopathic scoliosis?European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2024Article
- Does Spinal Cord Type Predict Intraoperative Neuro-Monitoring Alerts in Scoliosis Correction Surgery? A Systematic Review and Meta-Analysis of Operative and Radiologic Predictors.Global spine journal · 2024Review
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe purpose of this study is to investigate the effect of the deformity angular ratio (DAR) on intra-operative neuromonitoring (IONM) signal changes during posterior spinal fusion (PSF) without vertebral column resection (VCR).
methodsRetrospective review of severe pediatric spinal deformity patients treated with PSF without VCR or three-column osteotomy from 2008 to 2018. Exclusion criteria were prior instrumentation, lack of IONM, and incomplete radiographic data. Coronal DAR (C-DAR), sagittal DAR (S-DAR), and total DAR (T-DAR) were calculated and compared between patients with IONM signal loss and those without.
resultsTwo hundred and fifty-three patients met inclusion criteria. Forty-seven of two hundred and fifty-three (19%) patients had IONM signal loss. Intra-operative wake-up test was performed in seven cases; three of seven (43%) had a neurological deficit on wake-up test. All neurological deficits resolved at a mean of 41 days postop. IONM loss was associated with increased kyphosis (p = 0.003) and was not associated with Cobb angle (p = 0.16). S-DAR (p = 0.03) and T-DAR (p = 0.005) were associated with IONM signal loss but C-DAR was not (p = 0.06). Increased incidence of IONM signal loss was seen with S-DAR > 7 (p = 0.02) or T-DAR > 27 (p = 0.02). Twenty-four of ninety-two (26%) patients with S-DAR > 7 had IONM signal loss compared to twenty-three of one hundred and sixty-one (14%) with S-DAR ≤ 7 (OR, 2.1; 95% CI, 1.1-4.0). Seven of sixteen (44%) patients with T-DAR > 27 had signal loss compared to forty of two hundred and thirty-seven (17%) patients with T-DAR ≤ 27 (OR, 3.8; 95% CI, 1.3-10.9).
conclusionPatients with S-DAR > 7 or T-DAR > 27 have a higher risk of IONM loss during pediatric PSF even in the absence of a VCR or three-column osteotomies. LEVEL OF EVIDENCE II:
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