Higher intraoperative blood loss is associated with increased risk of intraoperative neuromonitoring data loss for the type 3 spinal cord shape during spinal deformity surgery

Chun Wai Hung; Fthimnir M. Hassan; Nathan J. Lee; Steven G. Roth; Justin K. Scheer; Erik Lewerenz; Joseph M. Lombardi; Zeeshan M. Sardar; Ronald A. Lehman; Lawrence G. Lenke

doi:10.1007/s43390-025-01090-3

Higher intraoperative blood loss is associated with increased risk of intraoperative neuromonitoring data loss for the type 3 spinal cord shape during spinal deformity surgery

Chun Wai Hung, Fthimnir M. Hassan, Nathan J. Lee, Steven G. Roth, Justin K. Scheer, Erik Lewerenz, Joseph M. Lombardi, Zeeshan M. Sardar, Ronald A. Lehman, Lawrence G. Lenke

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: To assess risk factors associated with an increased risk of intraoperative neuromonitoring (IONM) loss among spinal deformity patients with type 3 spinal cord (T3SC) shapes. Methods: This is a retrospective cohort study of adult and pediatric patients with T3SC undergoing spinal deformity surgery from a single center between 2016 and 2023. The primary outcome examined was whether there was IONM data loss. Demographic, clinical, operative, and radiographic variables were compared between patients with and without IONM data loss. Results: A total of 79 patients with T3SC were identified: 31 (39.2%) had IONM data loss, while 48 (60.8%) did not. There were no differences between the groups in terms of age, sex, or BMI (p > 0.05). There were no significant differences in the preoperative and postoperative coronal (C-DAR), sagittal (S-DAR), or total deformity angle ratio (T-DAR) (p > 0.05). There was no difference in the proportion of patients with a VCR, or in the mean instrumented number of levels. There was no difference in measured cord deformation using the area of the spinal cord shape as well as the long- and short-axis dimensions on an axial MRI cut. However, there was a statistically significantly higher EBL (1320.7 ± 614.0 vs. 1049.0 ± 468.4, p = 0.0316), TXA use (2619.8 ± 1333.1 cc vs. 1925.9 ± 1304.2, p = 0.0372), and cell saver salvage (468.5 ± 266.2 vs. 311.5 ± 266.2, p = 0.0264) in the IONM-Loss group. Conclusion: In this largest reported cohort patients with T3SC undergoing spinal deformity surgery, the only factors found to be significantly associated with an increased risk of IONM loss was higher EBL, higher autologous salvage transfused blood volume, and higher TXA given. It is critical for deformity surgeons to be aware of the importance of blood and hemodynamics management when treating this unique and high-risk population.

Original language	English (US)
Journal	Spine Deformity
Early online date	Apr 18 2025
DOIs	https://doi.org/10.1007/s43390-025-01090-3
State	E-pub ahead of print - Apr 18 2025

Keywords

Intraoperative neuromonitoring
Neurological complications
Spinal cord classification
Spinal deformity

ASJC Scopus subject areas

Orthopedics and Sports Medicine

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10.1007/s43390-025-01090-3

Cite this

Hung, C. W., Hassan, F. M., Lee, N. J., Roth, S. G., Scheer, J. K., Lewerenz, E., Lombardi, J. M., Sardar, Z. M., Lehman, R. A., & Lenke, L. G. (2025). Higher intraoperative blood loss is associated with increased risk of intraoperative neuromonitoring data loss for the type 3 spinal cord shape during spinal deformity surgery. Spine Deformity. Advance online publication. https://doi.org/10.1007/s43390-025-01090-3

@article{65810d33a3eb4a89959b66fcaa1bb33e,

title = "Higher intraoperative blood loss is associated with increased risk of intraoperative neuromonitoring data loss for the type 3 spinal cord shape during spinal deformity surgery",

abstract = "Purpose: To assess risk factors associated with an increased risk of intraoperative neuromonitoring (IONM) loss among spinal deformity patients with type 3 spinal cord (T3SC) shapes. Methods: This is a retrospective cohort study of adult and pediatric patients with T3SC undergoing spinal deformity surgery from a single center between 2016 and 2023. The primary outcome examined was whether there was IONM data loss. Demographic, clinical, operative, and radiographic variables were compared between patients with and without IONM data loss. Results: A total of 79 patients with T3SC were identified: 31 (39.2%) had IONM data loss, while 48 (60.8%) did not. There were no differences between the groups in terms of age, sex, or BMI (p > 0.05). There were no significant differences in the preoperative and postoperative coronal (C-DAR), sagittal (S-DAR), or total deformity angle ratio (T-DAR) (p > 0.05). There was no difference in the proportion of patients with a VCR, or in the mean instrumented number of levels. There was no difference in measured cord deformation using the area of the spinal cord shape as well as the long- and short-axis dimensions on an axial MRI cut. However, there was a statistically significantly higher EBL (1320.7 ± 614.0 vs. 1049.0 ± 468.4, p = 0.0316), TXA use (2619.8 ± 1333.1 cc vs. 1925.9 ± 1304.2, p = 0.0372), and cell saver salvage (468.5 ± 266.2 vs. 311.5 ± 266.2, p = 0.0264) in the IONM-Loss group. Conclusion: In this largest reported cohort patients with T3SC undergoing spinal deformity surgery, the only factors found to be significantly associated with an increased risk of IONM loss was higher EBL, higher autologous salvage transfused blood volume, and higher TXA given. It is critical for deformity surgeons to be aware of the importance of blood and hemodynamics management when treating this unique and high-risk population.",

keywords = "Intraoperative neuromonitoring, Neurological complications, Spinal cord classification, Spinal deformity",

author = "Hung, {Chun Wai} and Hassan, {Fthimnir M.} and Lee, {Nathan J.} and Roth, {Steven G.} and Scheer, {Justin K.} and Erik Lewerenz and Lombardi, {Joseph M.} and Sardar, {Zeeshan M.} and Lehman, {Ronald A.} and Lenke, {Lawrence G.}",

note = "Publisher Copyright: {\textcopyright} The Author(s), under exclusive licence to Scoliosis Research Society 2025.",

year = "2025",

month = apr,

day = "18",

doi = "10.1007/s43390-025-01090-3",

language = "English (US)",

journal = "Spine Deformity",

issn = "2212-134X",

publisher = "Springer Science and Business Media Deutschland GmbH",

}

TY - JOUR

T1 - Higher intraoperative blood loss is associated with increased risk of intraoperative neuromonitoring data loss for the type 3 spinal cord shape during spinal deformity surgery

AU - Hung, Chun Wai

AU - Hassan, Fthimnir M.

AU - Lee, Nathan J.

AU - Roth, Steven G.

AU - Scheer, Justin K.

AU - Lewerenz, Erik

AU - Lombardi, Joseph M.

AU - Sardar, Zeeshan M.

AU - Lehman, Ronald A.

AU - Lenke, Lawrence G.

PY - 2025/4/18

Y1 - 2025/4/18

N2 - Purpose: To assess risk factors associated with an increased risk of intraoperative neuromonitoring (IONM) loss among spinal deformity patients with type 3 spinal cord (T3SC) shapes. Methods: This is a retrospective cohort study of adult and pediatric patients with T3SC undergoing spinal deformity surgery from a single center between 2016 and 2023. The primary outcome examined was whether there was IONM data loss. Demographic, clinical, operative, and radiographic variables were compared between patients with and without IONM data loss. Results: A total of 79 patients with T3SC were identified: 31 (39.2%) had IONM data loss, while 48 (60.8%) did not. There were no differences between the groups in terms of age, sex, or BMI (p > 0.05). There were no significant differences in the preoperative and postoperative coronal (C-DAR), sagittal (S-DAR), or total deformity angle ratio (T-DAR) (p > 0.05). There was no difference in the proportion of patients with a VCR, or in the mean instrumented number of levels. There was no difference in measured cord deformation using the area of the spinal cord shape as well as the long- and short-axis dimensions on an axial MRI cut. However, there was a statistically significantly higher EBL (1320.7 ± 614.0 vs. 1049.0 ± 468.4, p = 0.0316), TXA use (2619.8 ± 1333.1 cc vs. 1925.9 ± 1304.2, p = 0.0372), and cell saver salvage (468.5 ± 266.2 vs. 311.5 ± 266.2, p = 0.0264) in the IONM-Loss group. Conclusion: In this largest reported cohort patients with T3SC undergoing spinal deformity surgery, the only factors found to be significantly associated with an increased risk of IONM loss was higher EBL, higher autologous salvage transfused blood volume, and higher TXA given. It is critical for deformity surgeons to be aware of the importance of blood and hemodynamics management when treating this unique and high-risk population.

AB - Purpose: To assess risk factors associated with an increased risk of intraoperative neuromonitoring (IONM) loss among spinal deformity patients with type 3 spinal cord (T3SC) shapes. Methods: This is a retrospective cohort study of adult and pediatric patients with T3SC undergoing spinal deformity surgery from a single center between 2016 and 2023. The primary outcome examined was whether there was IONM data loss. Demographic, clinical, operative, and radiographic variables were compared between patients with and without IONM data loss. Results: A total of 79 patients with T3SC were identified: 31 (39.2%) had IONM data loss, while 48 (60.8%) did not. There were no differences between the groups in terms of age, sex, or BMI (p > 0.05). There were no significant differences in the preoperative and postoperative coronal (C-DAR), sagittal (S-DAR), or total deformity angle ratio (T-DAR) (p > 0.05). There was no difference in the proportion of patients with a VCR, or in the mean instrumented number of levels. There was no difference in measured cord deformation using the area of the spinal cord shape as well as the long- and short-axis dimensions on an axial MRI cut. However, there was a statistically significantly higher EBL (1320.7 ± 614.0 vs. 1049.0 ± 468.4, p = 0.0316), TXA use (2619.8 ± 1333.1 cc vs. 1925.9 ± 1304.2, p = 0.0372), and cell saver salvage (468.5 ± 266.2 vs. 311.5 ± 266.2, p = 0.0264) in the IONM-Loss group. Conclusion: In this largest reported cohort patients with T3SC undergoing spinal deformity surgery, the only factors found to be significantly associated with an increased risk of IONM loss was higher EBL, higher autologous salvage transfused blood volume, and higher TXA given. It is critical for deformity surgeons to be aware of the importance of blood and hemodynamics management when treating this unique and high-risk population.

KW - Intraoperative neuromonitoring

KW - Neurological complications

KW - Spinal cord classification

KW - Spinal deformity

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U2 - 10.1007/s43390-025-01090-3

DO - 10.1007/s43390-025-01090-3

M3 - Article

C2 - 40249547

SN - 2212-134X

JO - Spine Deformity

JF - Spine Deformity

ER -

Higher intraoperative blood loss is associated with increased risk of intraoperative neuromonitoring data loss for the type 3 spinal cord shape during spinal deformity surgery

Abstract

Keywords

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