Neurophysiological Changes in Deformity Correction of Adolescent Idiopathic Scoliosis With Intraoperative Skull-Femoral Traction
Bibliographic record
Abstract
STUDY DESIGN: Retrospective review of 36 consecutive patients undergoing coronal plane deformity correction with intraoperative skull-femoral traction between 2005 and 2008 with motor evoked potential (MEP)/somatosensory evoked potential monitoring. OBJECTIVE: To determine the prevalence and significance of neurophysiological changes with intraoperative skull-femoral traction in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Intraoperative skeletal traction can be associated with spinal cord stretching and ischemia with resultant electrophysiological changes. The prevalence and risks of such changes and their clinical significance is unknown. METHODS: Thirty-seven procedures involving 36 patients (27 females and 9 males) with a mean age of 14.8 (12-18) years were divided into two groups on the basis of the presence (group 1, n = 18 procedures) or absence (group 2, n = 19) of significant MEP changes with surgery. They were compared with patients undergoing correction without traction (group 3). RESULTS: Significant differences among the groups were observed in mean preoperative Cobb angle (86° vs. 70° vs. 59°), mean intraoperative posttraction Cobb angle (50.0° vs. 34.6°), traction index (0.41 vs. 0.50), flexibility index (0.14 vs. 0.27 vs. 0.25), and presence of primary lumbar curves (0% vs. 32% vs. 14%). Initial onset of MEP amplitude loss (group 1) occurred at a mean of 94 (1-257) minutes from the onset of surgery, was bilateral in 13 procedures, and improved at a mean of 5.5 (1-29) minutes after decreasing or removing the traction. At closure, complete bilateral recovery to baseline was observed in 10 procedures, recovery to >50% baseline in five, and recovery to <50% baseline in three procedures. There were no neurologic deficits in this series. CONCLUSION: Intraoperative traction is associated with frequent changes in MEP monitoring. The thoracic location of the major curve, increasing Cobb angle, and rigidity of major curve are significant risk factors for changes in MEP with traction. The presence of any MEP recordings irrespective of its amplitude at closure was associated with normal neurological function. Somatosensory evoked potential monitoring did not correlate with the traction induced MEP amplitude changes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".