Surgery · 3 h ago
Large AIS cohort links curve magnitude to intraoperative monitoring alerts
A commentary on a study of more than 5,200 patients with adolescent idiopathic scoliosis reports that preoperative curve magnitude was the principal independent predictor of intraoperative neuromonitoring alerts. It also describes alert triggers and responses, while noting that the observational study cannot establish whether monitoring prevents neurologic injury.
- More than 5,200 AIS cases were analyzed.
- Curve magnitude was the main independent alert predictor.
- Hypotension was a notable reversible alert-related factor.
- The study cannot assess IONM effectiveness versus no monitoring.
Intraoperative neurophysiologic monitoring (IONM) is widely used during corrective surgery for adolescent idiopathic scoliosis (AIS), but evidence on alert risk and real-world responses has been limited. A study by CreveCoeur and colleagues analyzed more than 5,200 patients in a multicenter prospective database, examining alert predictors, triggering events, management strategies and postoperative outcomes. This journal commentary summarizes the study; the supplied text does not report the cohort’s exact alert rate or other numerical estimates.
The commentary reports that preoperative curve magnitude was the principal independent predictor of alerts. Lenke type-4 curves had the highest alert rate, although Lenke classification was not a significant predictor. Hypotension was highlighted as an important reversible physiologic factor in alert management. Patients who experienced alerts achieved radiographic correction comparable with patients without alerts.
Because nearly all patients received IONM, the study could not compare outcomes with unmonitored surgery or determine which patients require monitoring. Residual confounding is also possible, particularly because larger, more complex deformities may entail greater surgical and neurologic risk. The findings may inform risk assessment and multidisciplinary response planning, but they do not establish that IONM reduces neurologic injury or support changing monitoring practice. Individualized prediction models and AI-based approaches remain future research directions.
In practice
For teams performing corrective surgery for adolescent idiopathic scoliosis, the summarized cohort findings suggest that greater preoperative curve magnitude may help identify patients more likely to experience IONM alerts; the commentary also emphasizes attention to reversible physiologic factors such as hypotension and coordinated responses between surgical and anesthesia teams. These observational data do not show that IONM prevents neurologic injury, identify who can safely forgo monitoring, or establish a change in monitoring practice. Exact alert rates and effect estimates are not provided in the supplied text.
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The Journal of Bone and Joint Surgery, American Volume: From Detecting Alerts to Understanding Risk: Toward More Individualized Intraoperative Neuromonitoring in Adolescent Idiopathic Scoliosis Surgery ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.