{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:01:23Z","timestamp":1781157683704,"version":"3.54.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To describe the incidence and characteristics of multimodal intraoperative neuromonitoring (IONM) in pediatric spinal deformity surgery between two eras (1985\u20132008 vs. 2008\u20132024).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A review was conducted of 3316 consecutive pediatric spinal deformity surgeries (2008\u20132024) at a single institution. Neuromonitoring modalities included somatosensory-evoked potentials (SSEP), transcranial electrical motor-evoked potentials (TCeMEP), and descending neurogenic-evoked potentials (DNEP). Due to inherent cohort heterogeneity and evolving surgical standards over four decades, a descriptive analysis was prioritized to characterize shifts in monitoring performance and case complexity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\u00a0IONM alerts were more frequent in 2008\u20132024 at 4.1% (1 in 24) versus 2.2% (1 in 46). Highest alert rates were in kyphosis\/kyphoscoliosis (14.8% vs. 9.3%) and revision procedures (9.5% vs. 3.0%). Most alerts occurred during correction\/instrumentation (62.2% vs. 47%). Permanent neurologic deficits were more common in the modern cohort: 16 patients (0.48%, 1 in 207) versus 6 (0.17%, 1 in 573). False negatives occurred at similar frequencies (0.15% vs. 0.2%) but were more consequential, with 80% resulting in permanent deficits versus 14% previously. While lower in comparison to the historic era, IONM was associated with a disparity between alert frequent and observed permanent neurologic deficit rates with alerts occurring in 4.1% of cases and permanent deficits in 0.48% (historic era: 2.2 and 0.17%, respectively). However, this coincided with an increase in case complexity as evidenced by higher prevalence of three-column osteotomies and use of traction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multimodal IONM remains a critical adjunct in pediatric spinal deformity surgery, with alert events occurring in 4.1% of cases and an observed permanent neurologic deficit rate of 0.48%. False negatives, particularly nerve root related, remain a key limitation. Observed differences between eras likely reflect evolving case complexity, surgical techniques, and monitoring practices rather than changes in intrinsic monitoring performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43390-026-01453-4","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:47:58Z","timestamp":1781156878000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evolution of multimodal intraoperative neuromonitoring in pediatric spinal deformity surgery over 39\u00a0years: are we better?"],"prefix":"10.1007","author":[{"given":"Gabrielle A.","family":"Rogie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"IV","given":"Hilton C.","family":"Braithwaite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Bozorgmehr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Rakers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian A.","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3656-5962","authenticated-orcid":false,"given":"Scott J.","family":"Luhmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"1453_CR1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000001187","author":"A Al-Salahat","year":"2022","unstructured":"Al-Salahat A, Dilsaver DB, Chen YT, Sharma R, Kapoor N, Bernitsas E (2022) Trends and demographic disparities in the utilization of intraoperative neuromonitoring in the United States, 2008 to 2021. 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