Evidence map›Paper›PMID 39117941›Full record

ArticleSpine deformity2025

Does an improvement in cord-level intraoperative neuromonitoring data lead to a reduced risk for postoperative neurologic deficit in spine deformity surgery?

Nathan J Lee, Lawrence G Lenke, Mitchell Yeary, Alexandra Dionne, Chidebelum Nnake, Michael Fields, Matthew Simhon, Ted Shi, Varun Arvind, Anastasia Ferraro and 12 more

Abstract read
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In one paragraph

Article in Spine deformity, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Nathan J LeeDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Lawrence G LenkeDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.ORCID http://orcid.org/0000-0002-5595-4958
Mitchell YearyVagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Alexandra DionneVagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Chidebelum NnakeVagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Michael FieldsDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Matthew SimhonDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Ted ShiVagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Varun ArvindDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Anastasia FerraroDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Matthew CooneyDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Erik LewerenzDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.ORCID http://orcid.org/0009-0000-5118-8531
Justin L ReyesDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.ORCID http://orcid.org/0000-0001-6596-6488
Steven RothDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Chun Wai HungDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Justin K ScheerDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Thomas ZervosDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Earl D ThuetThe Och Spine Hospital, New York-Presbyterian, New York, NY, USA.
Joseph M LombardiDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Zeeshan M SardarDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.ORCID http://orcid.org/0000-0002-8417-3798
Ronald A LehmanDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
Fthimnir M HassanDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA. fh2444@cumc.columbia.edu.ORCID http://orcid.org/0000-0003-3928-8972

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo determine if an improvement in cord-level intraoperative neuromonitoring (IONM) data following data loss results in a reduced risk for new postoperative motor deficit in pediatric and adult spinal deformity surgery.

methodsA consecutive series of 1106 patients underwent spine surgery from 2015 to 2023 by a single surgeon. Cord alerts were defined by Somatosensory-Evoked Potentials (SSEP; warning criteria: 10% increase in latency or > 50% loss in amplitude) and Motor-Evoked Potentials (MEP; warning criteria: 75% loss in amplitude without return to acceptable limits after stimulation up 100 V above baseline level). Timing of IONM loss and recovery, interventions, and baseline/postoperative day 1 (POD1) lower extremity motor scores were analyzed.

resultsIONM Cord loss was noted in 4.8% (53/11,06) of patients and 34% (18/53) with cord alerts had a POD1 deficit compared to preoperative motor exam. MEP and SSEP loss attributed to 98.1% (52/53) and 39.6% (21/53) of cord alerts, respectively. Abnormal descending neurogenic-evoked potential (DNEP) was seen in 85.7% (12/14) and detected 91.7% (11/12) with POD1 deficit. Abnormal wake-up test (WUT) was seen in 38.5% (5/13) and detected 100% (5/5) with POD1 deficit. Most cord alerts occurred during a three-column osteotomy (N = 23/53, 43%); decompression (N = 12), compression (N = 7), exposure (N = 4), and rod placement (N = 14). Interventions were performed in all 53 patients with cord loss and included removing rods/less correction (N = 11), increasing mean arterial pressure alone (N = 10), and further decompression with three-column osteotomy (N = 9). After intervention, IONM data improved in 45(84.9%) patients (Full improvement: N = 28; Partial improvement: 17). For those with full and partial IONM improvement, the POD1 deficit was 10.7% (3/28) and 41.2% (7/17), respectively. For those without any IONM improvement (15.1%, 8/53), 100% (8/8) had a POD1 deficit, P < 0.001.

conclusionA full or partial improvement in IONM data loss after intraoperative intervention was significantly associated with a lower risk for POD1 deficit with an absolute risk reduction of 89.3% and 58.8%, respectively. All patients without IONM improvement had a POD1 neurologic deficit.

Indexed as

Intraoperative Neurophysiological MonitoringPostoperative ComplicationsSpinal CordSpineAdolescentAdultAgedChildEvoked Potentials, MotorEvoked Potentials, SomatosensoryFemaleHumansMaleMiddle AgedRetrospective StudiesYoung AdultComplicationsKyphosisNeuroimagingNeurophysiologyQuality improvementScoliosisSpinal cord injurySpinal deformity

Identifiers

PMID39117941

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.