Data from the Scoli-RISK 1 study demonstrated that rate of new postoperative lower extremity deficits following ASD surgery can be as high at 23% following discharge. IONM gives surgeons the ability to detect neurological changes, identify potential injuries, and the opportunity to respond accordingly. Although several studies have identified intraoperative factors that may lead to IONM changes and developed best practice guidelines to follow in the event of these changes, the effects of these interventions as well as the prognostic implications of IONM recovery on postoperative neurological function remains unclear.

In our newly-published study in Spine Deformity, we analyzed over 1,100 consecutive spinal deformity patients to determine if an improvement in cord-level IONM data following data loss results in a reduced risk of new postoperative motor deficits among pediatric and adult spinal deformity patients. IONM Cord loss was detected in 4.8% (n=53) of patients. Nearly 11% (3/28) and 41% (7/17) of patients who experience full and partial IONM improvement, respectively, following intraoperative intervention experienced neurological deficits on POD1, compared to 100% (8/8) of patients without IONM improvement. 87.5% of those without any IONM improvement continued to have a postoperative motor deficit following discharge.

These findings demonstrate that the majority of IONM alerts can improve with appropriate intraoperative interventions. Either a full or partial improvement in IONM data after intraoperative intervention can significantly lower the risk for early postoperative deficit.