Objective: The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age.Methods: 43 children, diagnosed with spinal pathologies were divided into two cohorts according totheir age and enrolled in the study. Those under the age of 6 consisted group A, whereas those betweenthe age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according totheir diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evokedpotentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded andevaluated at speciŞc time points for each patient.Results: Except for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There wasno false-negative whereas 9 false positive recordings due to physiological conditions that all recoveredintraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosiscomponent. The tcMEPs fully recovered by the end of the operation except for the patient with posttuberculosis kyphosis. There was no statistically signiŞcant difference in the mean threshold values withregard to transcranial stimulus intensity for the tcMEPs between the two groups.Conclusion: Compared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM iseffective for early childhood patients undergoing spinal surgery.Level of evidence: Level III, Diagnostic Study.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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Hamilton DK, Smith JS, Sansur CA, et al. Rates of new neurological deficitassociated with spine surgery based on 108,419 procedures: a report of thescoliosis research society morbidity and mortality committee.Spine. 2011;36:1218e1228.
Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologic deŞcits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol. 1995;96:6e11.
Iwasaki H, Tamaki T, Yoshida M, et al. EfŞcacy and limitations of current methods of intraoperative spinal cord monitoring. J Orthop Sci. 2003;8: e642.
Chen X, Sterio D, Ming X, et al. Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deŞcits. J Clin Neurophysiol. 2007;24:281e285.
Russell GB. Motor evoked potential. In: Russell GB, Rodichok LD, eds. Primer of Intraoperative Neurophysiologic Monitoring. Boston: Butterworth-Heinemann; :159. Frei FJ, Ryhult SE, Duitmann E, Haster CC, Luetschg J, Erb TO. Intraoperative monitoring of motor-evoked potentials in children undergoing spinal surgery. Spine. 2007;32:911e917.
Beric A. Transcranial electrical and magnetic stimulation. In: Niedermeyer E, Lopes da Silva F, eds. Electroencephalography. Baltimore: Williams& Wilkins; :836e850.
Nezu A, Kimura S, Uehara S, Kobayashi T, Tanaka M, Saito K. Magnetic stimu- lation of motor cortex in children: maturity of corticospinal pathway and problem of clinical application. Brain Dev. 1997;19:176e180.
Thompson GH, Lenke LE, Akbarnia BA, McCarthy RE, Campbell RM. Early onset scoliosis: future directions. J Bone J Surg Am. 2007;89:163e166.
Beyazova M, Senkoylu A, Zinnuroglu M. Intraoperative neurophysiologic monitoring in spine surgery: Gazi Medical School experience. J Turk Spinal Surg. ;21:49e58.
Luk KDK, Hu Y, Wong YW, Leong JC. Variability of somatosensory evoked po- tentials in different stages of scoliosis surgery. Spine. 1999;24:1799e1804.
Gogtay N, Giedd JN, Lusk L, et al. Dynamic mapping of human cortical devel- opment during childhood through early adulthood. Proc Natl Acad Sci. ;101:8174e8179.
Barker AT, Freestone IL, Jalinous R, Jarratt JA. Magnetic stimulation of the hu- man brain and peripheral nervous system: an introduction and the results of an initial clinical evaluation. Neurosurgery. 1987;20:100e109.
Koh TH, Eyre JA. Maturation of corticospinal tracts assessed by electromagnetic stimulation of the motor cortex. Arch Dis Child. 1988;63:1347e1352.
Fulkerson DH, Satyan KB, Wilder LM, et al. Intraoperative monitoring of motor evoked potentials in very young children. J Neurosurg Pediatr. 2011;7:311e317.
Yang J, Huang Z, Shu H, et al. Improving successful rate of transcranial electrical motor-evoked potentials monitoring during spinal surgery in young children. Eur Spine J. 2012;21:980e984.
Moller AR. Intraoperative Neurophysiologic Monitoring. 2nd ed. New York: Humana Press Inc; 2006:185.
Simon MV. Intraoperative Neurophysiology a Comprehensive Guide to Monitoring and Mapping. 1st ed. Totowa (NJ): Demos Medical Publishing; 2009:18.
McIntyre IW, Francis L, McAuliffe JJ. Transcranial motor-evoked potentials are more readily acquired than somatosensory-evoked potentials in children younger than 6 years. Anesth Analg. 2016;122:212e218.