Study design: Analysis of a prospective series of 300 consecutive cases undergoing intraoperative monitoring in pediatric orthopedic spinal surgery, of which 10% were children younger than 4 years.
Objective: Determine feasibility and performance of intraoperative monitoring in children younger than 4 years. Analyze distinct physiopathologic mechanisms of relevant alerts.
Summary of background data: There are few studies in the literature concerning the intraoperative monitoring of children younger than 4 years. During childhood, the development of sensori-motor pathways is dominated by two coexisting phenomena, which have opposite effects: maturation decreasing latencies and height increasing them.
Methods: We used intraoperative somatosensory-evoked potentials and neurogenic mixed evoked potentials with a flexible bipolar epidural electrode. Uniform total intravenous anesthesia was used.
Results: Values of sensitivity and specificity of the monitoring showed slight differences between patients younger than 4 years versus older patients. There was no false-negative outcome. Various tendencies were highlighted. There were more true positive alerts for secondary etiologies than for idiopathic ones, for revision spinal surgeries than for index ones, and for boys than for girls. There were no more true positive alerts for children younger than 4 years than for older patients whereas the proportion of hemivertebrae was obviously greater for the younger group. Relevant monitoring alerts were more frequent in case of kyphoscoliosis. This is highlighted in case reports.
Conclusion: In some cases of kyphoscoliosis, during a posterior-based vertebral column resection, monitoring changes were corrected by positioning a rod that allowed correction of the position of the spine in the sagittal plane. Intraoperative spinal cord monitoring can be performed in children younger than 4 years and allows real-time assessment of spinal functional integrity.