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Item does not contain fulltext PURPOSE: Although multimodal IONM has reached a widespread use, several unresolved issues have remained in clinical practice. The aim was to determine differences in approaches to form a basis for taking actions to improve patient safety globally. METHODS: A survey comprising 19 questions in four sections (demographics, setup, routine practices and reaction to alerts) was distributed to the membership of the SRS. RESULTS: Of the estimated 1300 members, 205 (~ 15%) completed the survey. Respondent demographics reflected SRS member distribution. Most of the respondents had > 10 years of experience. TcMEP and SSEP were available to > 95%. Less than 5% reported that a MD/PhD with neurophysiology background routinely examines patients preoperatively, while 19% would consult if requested. After an uneventful case, 36% reported that they would decrease sedation and check motor function if the patient was to be transferred to ICU intubated. Reactions to dropped signals that recovered or did not fully recover varied between attempting the same correction to aborting the surgery with no rods and returning another day, with or without implant removal. After a decrease of signals, 85.7% use steroids of varied doses. Of the respondents, 53.7% reported using the consensus-created checklist by Vitale et al. Approximately, 14% reported never using the wake-up test while others use it for various conditions. CONCLUSION: The responses of 205 experienced SRS members from different regions of the world showed that surgeons had different approaches in their routine IONM practices and in the handling of alerts. This survey indicates the need for additional studies to identify best practices.

BACKGROUND CONTEXT Vertebral body tethering (VBT), a flexible compression-based growth modulation technique, was claimed to prevent disc degeneration due to its less rigid nature compared to other growth-friendly techniques. Yet, the consequences of VBT surgery on discs and facet joints have not been precisely acknowledged. PURPOSE The purpose of this study was to determine the changes in the intermediate and adjacent levels at least 2 years after surgery. STUDY DESIGN/SETTING Prospectively-followed consecutive patient cohort PATIENT SAMPLE Adolescent idiopathic scoliosis patients who underwent thoracoscopic VBT between 2014 and 2017 were included. OUTCOME MEASURES Degeneration of the intervertebral discs using the Pfirrmann classification; Degeneration of facet joints using a scale of 0 to 3. METHODS Demographic, perioperative, clinical, radiographic data were collected. Skeletal maturity and height gain were assessed in every follow-up. Overcorrection, tether breakage, mechanical and pulmonary complications as well as readmission and reoperations were recorded. MRIs taken before surgery and at a minimum of 2 years follow-up were evaluated for degeneration at the intermediate and adjacent segment intervertebral discs and facet joints by a blinded senior radiologist and compared. RESULTS Twenty-five patients with a mean of 38.6±10.6 months (24–62) of follow-up were included. The mean age at surgery was 12.2 (10–14), and the median Sanders stage was 3 (1–7). A mean of 7.7±1.1 (6–11) levels were tethered. The mean preoperative main thoracic curve magnitude of 46°±7.7° was corrected to 23.3°±5.9° postoperatively, which was subsequently modulated to 12° ±11.5° during the follow-up. At the time of the MRI (mean 29±9.5 (24–62) months), the median Sanders stages was 7 (5–8). A total of 217 levels of discs and bilateral facet joints were evaluated in the preoperative and follow-up MRI images. Analyses of disc and facet scores revealed no significant differences between patients. Deterioration of previously degenerated discs was noted in one patient (from grade 2 to 3), while previously healthy lower adjacent facet joints were degenerated (grade 2) in another patient. CONCLUSIONS Intermediate discs and facet joints were preserved after growth modulation with VBT surgery at a mean of 29 months of follow-up. Studies in larger cohorts with longer follow-up are warranted to have more in-depth analyses of the effects of relative stabilization and altered biomechanical loads.

BACKGROUND CONTEXT Disc health after various growth modulation techniques have been assessed in animal models, and tethering was claimed to prevent degeneration due to its less rigid nature compared to other growth-friendly techniques. Yet, the results of animal studies wherein tethering is applied on healthy spines to create a deformity cannot be extrapolated to humans, in which tethering is used for deformity correction. As biomechanical properties are different, effects of vertebral body tethering (VBT) surgery on discs and facet joints in clinical series are not precisely acknowledged. There are concerns that VBT surgery may cause degeneration at both intermediate and adjacent levels. PURPOSE Our aim was to investigate the integrity of discs and facet joints that are subject to compressive forces and relative stabilization during growth modulation. STUDY DESIGN/SETTING Retrospective analysis of a prospectively collected data. PATIENT SAMPLE This study included 25 (23F, 2M) consecutive adolescent idiopathic scoliosis (AIS) patients with a mean follow-up of 29 (24-62) months who underwent thoracoscopic VBT surgery between 2014 to 2017 were included. OUTCOME MEASURES Disc and facet joint degeneration scores on MRI. Methods Demographic, perioperative and radiographic data were collected. Overcorrection, mechanical and pulmonary complications, and reoperations were recorded. MRIs taken before surgery and at a minimum of 2 years of follow-up were evaluated for degeneration at the intermediate and adjacent segment intervertebral discs and facet joints by a blinded senior radiologist and compared. Discs were assessed using Pfirrmann grade. Facet joint degeneration was graded on a scale of 0-3. Changes from preop to follow-up MRIs were analyzed using McNemar's Test and Related Samples Marginal Homogeneity Test. Results The mean age at surgery was 12.2 (10–14) years and median Sanders stage was 3 (1-7). A mean of 7.7±1.1 (6-11) levels were tethered. Preoperative mean height of 155.3 (130-178) cm was increased to 163.4 (149-187) cm at latest follow-up. The mean preoperative MT curve magnitude of 46°±7.7° was corrected to 23.3°±5.9° at first erect, which was modulated to 12°±11.5° during follow-up. There was 1 (4%) broken tether, 5 (20%) overcorrected curves, 3 (12%) implant-related complications and 1 (4%) reoperation for a thoracoscopic tether release before the follow-up MRI was obtained. A total of 217 levels of discs and bilateral facet joints, were evaluated in the preoperative and follow-up MRI images. Analyses of disc and facet joint scores revealed no significant differences between patients. One case (4%) with an increase in disc scores already had multilevel moderate degeneration preoperatively, while another case (4%) displayed a single-level new-onset grade-2 bilateral facet degeneration. Conclusions This study reports MRI findings of 25 rapid and steady growing adolescents (Sanders 2-7) who had undergone thoracoscopic VBT surgery. At an average of 29 months (24-62) after growth modulation with VBT surgery, radiographic degenerative findings were not present in 97.7% of the intermediate and adjacent discs and 99.3% of the facet joints. Studies with longer follow-up are warranted to further analyze the effects of relative stabilization and altered biomechanical loads. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.