Evidence map›Paper›PMID 42663939›Full record

ArticleSpine deformity2026

Intraoperative neuromonitoring alerts during surgery for congenital spinal deformity: prevalence, risk factors, and outcomes in a prospective study of 100 patients.

Anuj Gupta, Brett A Shannon, Munish C Gupta, Petya K Yorgova, Oheneba Boachie-Adjei, Paul D Sponseller, Jennifer M Bauer, Burt Yaszay, Purnendu Gupta, Kwadwo Poku Yankey and 9 more

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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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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

19 authors.

Anuj GuptaDepartment of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE, 19803, USA.
Brett A ShannonDepartment of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE, 19803, USA.
Munish C GuptaDepartment of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, MS, USA.
Petya K YorgovaDepartment of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE, 19803, USA.
Oheneba Boachie-AdjeiDivision of Complex Spine Deformity, The FOCOS Hospital, Accra, Ghana.
Paul D SponsellerDepartment of Orthopaedic Surgery, The John Hopkins University, Baltimore, MD, USA.
Jennifer M BauerDepartment of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Burt YaszayDepartment of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Purnendu GuptaShriners Hospitals for Children, Chicago, IL, USA.
Kwadwo Poku YankeyDivision of Complex Spine Deformity, The FOCOS Hospital, Accra, Ghana.
Peter O NewtonDepartment of Orthopedics, Rady Children's Hospital, San Diego, CA, USA.
Michael P KellyDepartment of Orthopedics, Rady Children's Hospital, San Diego, CA, USA.
Amer F SamdaniDepartment of Pediatric Orthopedic Surgery, Shriners Hospital for Children, Philadelphia, PA, USA.
Joshua M PahysDepartment of Pediatric Orthopedic Surgery, Shriners Hospital for Children, Philadelphia, PA, USA.
Daniel J SucatoDepartment of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX, USA.
David B BumpassDepartment of Orthopedic Surgery, University of Arkansas, Little Rock, AR, USA.
Lawrence G LenkeDepartment of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York, Presbyterian, New York, NY, USA.
Suken A ShahDepartment of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE, 19803, USA. suken.shah@nemours.org.ORCID http://orcid.org/0000-0003-4885-0138
Fox Pediatric Congenital Spinal Deformity Study Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSurgical goals for congenital spinal deformity (CSD) include correction of deformity and prevention of progression without affecting neurological function. CSD has a higher incidence of intraoperative neuromonitoring (IONM) alerts than other scoliosis types and a potential for risk of postoperative neurological deficit. This study investigates incidence, risk factors, and outcomes associated with IONM alerts in surgically treated CSD.

methodsA prospectively collected pediatric database was queried for surgically managed patients with CSD. Demographic, surgical, and IONM details were analyzed and neurological outcomes were tracked.

resultsOne hundred patients were included. Diagnoses were scoliosis, kyphosis, and kyphoscoliosis. Mean dominant-plane curvature was 64°. Hemivertebrae were present in 51 patients. IONM alerts occurred in 19% of cases: 11 transcranial motor-evoked potential (TcMEP) alone and 8 both TcMEP and somatosensory-evoked potential (SSEP). Fifteen alerts occurred in patients undergoing 3-column osteotomy (3CO) and 4 posterior spinal fusion (PSF) alone. Significant risk factors for IONM alerts included curve magnitude, sagittal-deformity angular ratio (DAR), total-DAR, % blood loss (%BL), and number of levels fused. The 40% alert likelihood values were 98° (curve magnitude), 17 (S-DAR), 27.1 (T-DAR), and 52% (%BL). 3CO was not statistically correlated with a higher IONM alert rate (p = 0.145); however, higher alerts were seen in patients with osteotomy (23% vs 11%). Twenty-six alerts occurred in 19 patients; 5 had more than one alert. Most occurred during hemivertebrae excision/vertebral column resection and rod/correction maneuvers. Intraoperative mitigation measures included increasing mean arterial pressure and reducing correction. Signals returned to baseline in 58% of alerts. Four of 19 cases had a postoperative neurological deficit-all with combined TcMEP and SSEP loss-but all recovered by 4-6 weeks.

conclusionThis is the first, large, contemporary, multicenter prospective study to highlight a 19% incidence of IONM alerts and favorable outcomes of initial neurologic deficit in CSD. Large curve magnitude, sagittal-DAR, total-DAR, more levels fused, and %BL have significant risk associations, and 3CO cases were attributed the highest risk. Measures adopted by spine surgeons intraoperatively are described. Though most alerts can revert to baseline and do not culminate in clinical deficit, the combined loss of TcMEP and SSEP should be considered especially threatening. LEVEL OF EVIDENCE: Level III.

Indexed as

Congenital spine deformityNeurologic deficitNeurologic monitoringScoliosisSurgical complication

Identifiers

PMID42663939

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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.