Patients without intraoperative neuromonitoring (IONM) alerts during implantation of rib based growing constructs did not sustain neurologic injury during.

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Patients without intraoperative neuromonitoring (IONM) alerts during implantation of rib based growing constructs did not sustain neurologic injury during subsequent routine expansions Jaren LaGreca, BA Tara Flynn, BA Patrick J. Cahill, MD Amer Samdani, MD Michael G. Vitale, MD, MPH Ron El-Hawary, MD, MSc, FRCS(C) John T. Smith, MD Jonathan H. Phillips, MD John M. Flynn, MD Michael Glotzbecker, MD Sumeet Garg, MD

Introduction Skaggs JBJS rib based growing surgery procedures –0.5% overall neurologic injury rate –0% (1185 procedures) – expansions Neuromonitoring –1 alert during expansion Child with history of alert at implant

Study Questions If a patient has no neuromonitoring (IONM) alerts during implant of rib based growing construct, is monitoring necessary during expansion procedures? Describe the rate of IONM alerts and neurologic injury

Hypothesis Monitoring does not identify new neurologic injury during expansion of rib based growing constructs in children without monitoring alerts during initial implantation

Methods Multicenter Retrospective Review rib based growing surgery treatment from All available IONM reports were reviewed Cases with IONM alerts or neurologic injury had additional chart review

Participating Sites

Total Procedures 2,355 No / Unconfirmed IONM 1,816 Confirmed IONM 539 Cases of IONM Alert 9 Rate of IONM alert 1.7% (9/539)

IONM Expansion Alerts 1/3 was in a child without prior neurologic injury or IONM alert 2/3 alerts were in a child with prior history of IONM alert

Rate of Neurologic Injury 0.1% for All Procedures (3/2,355) Neurologic Injury 3 Implant Expansion RevisionRemoval

Conclusions IONM did not identify new neurologic injuries during rib based growing surgery expansion procedures in patients without a history of IONM alert or neurologic injury The highest rate of neurologic injury was during implant procedures There were no instances of neurologic injury during expansion, revision, or removal procedures

Significance IONM may not be necessary in patients undergoing rib based growing surgery expansion procedures who have not previously had IONM alerts or neurologic injury

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