PMID- 35121118 OWN - NLM STAT- MEDLINE DCOM- 20220726 LR - 20220726 IS - 1532-6500 (Electronic) IS - 1058-2746 (Linking) VI - 31 IP - 8 DP - 2022 Aug TI - Utilization of intraoperative neuromonitoring during the Woodward procedure for treatment of Sprengel deformity. PG - e405-e412 LID - S1058-2746(22)00184-7 [pii] LID - 10.1016/j.jse.2021.12.040 [doi] AB - BACKGROUND: Brachial plexus injury (BPI) leading to palsy of the upper extremities is the most serious complication of the Woodward procedure for treatment of Sprengel deformity. Intraoperative neuromonitoring (IONM) is widely used for detecting emerging spinal cord or peripheral nerve injury during spinal and shoulder surgery. However, to date, its utilization in pediatric patients with Sprengel deformity is limited. Furthermore, it remains unclear whether IONM can help prevent BPI during surgery. The purpose of the current study was to assess the feasibility and effectiveness of IONM for early identification and prevention of nerve injury during the Woodward procedure. METHODS: We retrospectively reviewed the records of patients who underwent the Woodward procedure for Sprengel deformity at our institution between January 2017 and January 2020. IONM, including somatosensory evoked potentials (SEP) and motor evoked potentials (MEPs), was performed in all patients. Detailed IONM data were collected and analyzed. Preoperative and postoperative cosmetic appearance (according to the Cavendish classification), shoulder joint abduction function, and radiologic evaluation of the scapula were reviewed. Surgical complications were recorded. RESULTS: Forty-six patients (19 girls, 27 boys) were included (mean age, 5.1 +/- 2.1 years). Both SEP and MEP (amplitude of the abductor pollicis) were successfully performed (100%). MEP alerts occurred in 3 patients (6.5%). After scapula position adjustment, signals recovered in 2 patients and remained unchanged in 1 patient-this patient exhibited postoperative motor deficits that resolved completely by 4 months recovery. The SEP amplitudes decreased in all 3 patients but did not reach the warning criteria. Forty patients were classified as grade III and 6 as grade IV in the Cavendish classification, whereas 35 patients were classified as grade II and 11 as grade III in the Rigault scale. The preoperative Cavendish grade was III (III, IV) and the postoperative Cavendish grade was I (I, II) (chi(2) = 88.098, P < .001). The preoperative Rigault grade was II (II, III) and the postoperative Rigault grade was I (I, II) (chi(2) = 62.133, P < .001). The mean arc of shoulder joint abduction improved from 99 degrees +/- 8 degrees to 167 degrees +/- 7 degrees (t = -45.871, P < .001) after surgery. Except for temporary motor deficits detected in 1 patient, no other postoperative complications were observed through the time of final follow-up. CONCLUSION: IONM during the Woodward procedure for Sprengel deformity is feasible and effective in detecting intraoperative neurologic changes and may be effective in preventing BPI associated with surgery. CI - Copyright (c) 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved. FAU - Feng, Lei AU - Feng L AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Zhang, Xuejun AU - Zhang X AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. Electronic address: zhang-x-j04@163.com. FAU - Guo, Dong AU - Guo D AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Li, Chengxin AU - Li C AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Qi, Xinyu AU - Qi X AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Bai, Yunsong AU - Bai Y AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Cao, Jun AU - Cao J AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Sun, Baosheng AU - Sun B AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Yao, Ziming AU - Yao Z AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Gao, Jingchun AU - Gao J AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Cui, Lanyue AU - Cui L AD - Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. FAU - Guo, Lanjun AU - Guo L AD - Department of Surgical Neuromonitoring, University of California, San Francisco, CA, USA. LA - eng PT - Journal Article DEP - 20220201 PL - United States TA - J Shoulder Elbow Surg JT - Journal of shoulder and elbow surgery JID - 9206499 RN - Sprengel deformity SB - IM MH - Child MH - Child, Preschool MH - Congenital Abnormalities MH - Evoked Potentials, Motor/physiology MH - Evoked Potentials, Somatosensory/physiology MH - Female MH - Humans MH - Male MH - Retrospective Studies MH - Scapula/abnormalities/surgery MH - *Shoulder Joint/abnormalities/surgery OTO - NOTNLM OT - Sprengel deformity OT - brachial plexus OT - intraoperative neuromonitoring OT - motor evoked potential OT - somatosensory evoked potential EDAT- 2022/02/06 06:00 MHDA- 2022/07/27 06:00 CRDT- 2022/02/05 05:38 PHST- 2021/07/06 00:00 [received] PHST- 2021/12/18 00:00 [revised] PHST- 2021/12/25 00:00 [accepted] PHST- 2022/02/06 06:00 [pubmed] PHST- 2022/07/27 06:00 [medline] PHST- 2022/02/05 05:38 [entrez] AID - S1058-2746(22)00184-7 [pii] AID - 10.1016/j.jse.2021.12.040 [doi] PST - ppublish SO - J Shoulder Elbow Surg. 2022 Aug;31(8):e405-e412. doi: 10.1016/j.jse.2021.12.040. Epub 2022 Feb 1.