ArticleSpine deformity2026
Evolution of multimodal intraoperative neuromonitoring in pediatric spinal deformity surgery over 39 years: are we better?
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
purposeTo describe the incidence and characteristics of multimodal intraoperative neuromonitoring (IONM) in pediatric spinal deformity surgery between two eras (1985-2008 vs. 2008-2024).
methodsA review was conducted of 3316 consecutive pediatric spinal deformity surgeries (2008-2024) at a single institution. Neuromonitoring modalities included somatosensory-evoked potentials (SSEP), transcranial electrical motor-evoked potentials (TCeMEP), and descending neurogenic-evoked potentials (DNEP). Due to inherent cohort heterogeneity and evolving surgical standards over four decades, a descriptive analysis was prioritized to characterize shifts in monitoring performance and case complexity.
resultsIONM alerts were more frequent in 2008-2024 at 4.1% (1 in 24) versus 2.2% (1 in 46). Highest alert rates were in kyphosis/kyphoscoliosis (14.8% vs. 9.3%) and revision procedures (9.5% vs. 3.0%). Most alerts occurred during correction/instrumentation (62.2% vs. 47%). Permanent neurologic deficits were more common in the modern cohort: 16 patients (0.48%, 1 in 207) versus 6 (0.17%, 1 in 573). False negatives occurred at similar frequencies (0.15% vs. 0.2%) but were more consequential, with 80% resulting in permanent deficits versus 14% previously. While lower in comparison to the historic era, IONM was associated with a disparity between alert frequent and observed permanent neurologic deficit rates with alerts occurring in 4.1% of cases and permanent deficits in 0.48% (historic era: 2.2 and 0.17%, respectively). However, this coincided with an increase in case complexity as evidenced by higher prevalence of three-column osteotomies and use of traction.
conclusionMultimodal IONM remains a critical adjunct in pediatric spinal deformity surgery, with alert events occurring in 4.1% of cases and an observed permanent neurologic deficit rate of 0.48%. False negatives, particularly nerve root related, remain a key limitation. Observed differences between eras likely reflect evolving case complexity, surgical techniques, and monitoring practices rather than changes in intrinsic monitoring performance.
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