Intraoperative Neuromonitoring Applications and Issues in Pediatric Spinal Deformity Surgery

Intraoperative neuromonitoring for deformity surgery in the very young or in neurologically abnormal patients may present special challenges for the surgeon and intraoperative monitoring team. Circumstances where monitoring may not be achievable, indications for monitoring in exceptional procedures, and safety considerations with monitoring itself are described for some less common pediatric spinal deformities. Strategies for responding to adverse intraoperative neuromonitoring changes are reviewed. Awareness of these issues is useful for planning spinal deformity surgery in the young.