{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:33:39Z","timestamp":1787927619746,"version":"build-2784847793"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Fox Pediatric Congenital Spinal Deformity Study to Washington University School of Medicine"}],"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>Background<\/jats:title>\n                    <jats:p>Surgical goals for congenital spinal deformity (CSD) include correction of deformity and prevention of progression without affecting neurological function. CSD has a higher incidence of intraoperative neuromonitoring (IONM) alerts than other scoliosis types and a potential for risk of postoperative neurological deficit. This study investigates incidence, risk factors, and outcomes associated with IONM alerts in surgically treated CSD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospectively collected pediatric database was queried for surgically managed patients with CSD. Demographic, surgical, and IONM details were analyzed and neurological outcomes were tracked.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One hundred patients were included. Diagnoses were scoliosis, kyphosis, and kyphoscoliosis. Mean dominant-plane curvature was 64\u00b0. Hemivertebrae were present in 51 patients. IONM alerts occurred in 19% of cases: 11 transcranial motor-evoked potential (TcMEP) alone and 8 both TcMEP and somatosensory-evoked potential (SSEP). Fifteen alerts occurred in patients undergoing 3-column osteotomy (3CO) and 4 posterior spinal fusion (PSF) alone. Significant risk factors for IONM alerts included curve magnitude, sagittal-deformity angular ratio (DAR), total-DAR, % blood loss (%BL), and number of levels fused. The 40% alert likelihood values were 98\u00b0 (curve magnitude), 17 (S-DAR), 27.1 (T-DAR), and 52% (%BL). 3CO was not statistically correlated with a higher IONM alert rate (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.145); however, higher alerts were seen in patients with osteotomy (23% vs 11%). Twenty-six alerts occurred in 19 patients; 5 had more than one alert. Most occurred during hemivertebrae excision\/vertebral column resection and rod\/correction maneuvers. Intraoperative mitigation measures included increasing mean arterial pressure and reducing correction. Signals returned to baseline in 58% of alerts. Four of 19 cases had a postoperative neurological deficit\u2013all with combined TcMEP and SSEP loss\u2013but all recovered by 4\u20136\u00a0weeks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first, large, contemporary, multicenter prospective study to highlight a 19% incidence of IONM alerts and favorable outcomes of initial neurologic deficit in CSD. Large curve magnitude, sagittal-DAR, total-DAR, more levels fused, and %BL have significant risk associations, and 3CO cases were attributed the highest risk. Measures adopted by spine surgeons intraoperatively are described. Though most alerts can revert to baseline and do not culminate in clinical deficit, the combined loss of TcMEP and SSEP should be considered especially threatening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43390-026-01531-7","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:15:59Z","timestamp":1787926559000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative neuromonitoring alerts during surgery for congenital spinal deformity: prevalence, risk factors, and outcomes in a prospective study of 100 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Glob Spine J 9(1 Suppl):15S-21S","journal-title":"Glob Spine J"}],"container-title":["Spine Deformity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-026-01531-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43390-026-01531-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-026-01531-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:16:00Z","timestamp":1787926560000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43390-026-01531-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":32,"alternative-id":["1531"],"URL":"https:\/\/doi.org\/10.1007\/s43390-026-01531-7","relation":{},"ISSN":["2212-134X","2212-1358"],"issn-type":[{"value":"2212-134X","type":"print"},{"value":"2212-1358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"assertion":[{"value":"9 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Anuj Gupta, Brett A. Shannon, Petya K. Yorgova, and Kwadwo Poku Yankey declare they have no financial or nonfinancial interests. Munish C. Gupta declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Dr. Gupta has received royalties from DePuy Synthes Spine, Globus Medical, and Innomed; consulting fees from Medtronic, Globus Medical, and DePuy Synthes Spine; Payment or Honoria from Yale Grand Rounds, Georgetown Grand Rounds, and SMAIO; meeting\/travel support for faculty from Argentine Spine Society, Columbian Spine Society, Brazilian Spine Society, Scoliosis Research Society, SMAIO, Broadwater, and Japanese Orthopaedic Association; Board of Directors for Scoliosis Research Society and Twentieth Century Orthopaedic Association (unpaid); personal stock in Johnson and Johnson and SMAIO. Oheneba Boachie-Adjei declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Dr. Boachie-Adjei declares royalties from K2M\/WEIGAO. Paul Dr. Sponseller declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Jennifer M. Bauer declares teaching\/consulting fees from Johnson and Johnson MedTech, Orthopediatrics, Globus Medical NuVasive; Past board member (2023-May 2025) of Pediatric Orthopaedic Society of North America (unpaid). Burt Yaszay declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study since the initial planning of this work. Dr. Yaszay declares royalties from NuVasive, Stryker, Orthopediatrics, and Globus Medical; consulting fees from Stryker, Nuvasive, DePuy Synthes Spine, Pacira, and Medtronic; patents from K2M; leadership or fiduciary role in CUMG, Pediatric Spine Foundation, Setting Scoliosis Straight, Global Spine Outreach, and Scoliosis Research Society (unpaid). Purnendu Gupta declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Dr. Gupta declares consulting fees from Johnson and Johnson MedTech; payment or Honoria from Johnson and Johnson MedTech. Peter O. Newton declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity. Dr. Newton declares grants or contracts from DePuy Synthes Spine, Scoliosis Research Society, EOS Imaging, Nuvasive, Orthopediatrics, Stryker\/K2M\/VB Spine, Alphatech, and Setting Scoliosis Straight Foundation; royalties from DePuy Synthes Spine, Thieme Publishing, Stryker\/K2M\/VB Spine; consulting fees from Globus Medical, Stryker Spine\/K2M\/VB Spine, Pacira, Orthofix, Medtronic; payment or Honoria from Stryker\/K2M\/VB Spine; patents for Constrained motion bone screw assembly, Instruments and methods for manipulating vertebra, Low profile spinal tethering devices, Screw placement guide, Head-to-head transverse connector, Sacral or iliac connector, Pelvic obliquity correction instrumentation, bone anchor apparatus, Fixation device, Occipital plate, Polyaxial lateral offset connector, Modular screw, Fixation device, Modular offset screw, and Bone tie methods; past president and board executive committee member for Setting Scoliosis Straight Foundation (unpaid); Board member Rady Children\u2019s Specialists of San Diego and International Pediatric Orthopedic Think Tank (unpaid); stock in Accelus, Spinology, and SeeAll_AI. Michael P. Kelly declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Dr. Kelly declares Honoria from Wolters Kluwer for editorial responsibilities; travel support from AO Spine. Amer F. Samdani declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Dr. Samdani declares royalties from Globus NuVasive and HighRidge Medical; consulting fees from DePuy Synthes Spine, Ethicon Endosurgery, Globus NuVasive, HighRidge Medical, Medical Device Business Services, Medtronic, and Mirus; board and executive committee for Setting Scoliosis Straight Foundation and executive committee for Pediatric Spine Study Group (unpaid). Joshua M. Pahys declares consulting fees from Globus Medical, HighRidge Medical, and DePuy Synthes Spine; director at large of Scoliosis Research Society (unpaid). Daniel J. Sucato declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Dr. Sucato declares royalties from Globus Medical; board member of Pediatric Orthopaedic Society of North America (unpaid). David B. Bumpass declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Dr. Bumpass declares consulting fees from Medtronic and Orthopediatrics; payment or Honoria from Medtronic; patent from Orthopediatrics. Lawrence G. Lenke declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Dr. Lenke declares consulting fees and royalties from Medtronic, Abryx, EOS Technologies, and Acuity Surgical; grant support from Scoliosis Research Society, EOS, and Setting Scoliosis Straight Foundation; travel support from Broadwater, Scoliosis Research Society, and AOSpine. Fellowship support from AOSpine; philanthropic research funding from grateful patient\/family from Evans Family Donation and Fox Family Foundation. Suken A. Shah declares that a private contribution to Washington University School of Medicine has been made by the Fox Pediatric Congenital Spinal Deformity Study. Dr. Shah declares grants from Setting Scoliosis Straight Foundation; royalties from Johnson and Johnson MedTech; consulting fees from Johnson and Johnson MedTech; leadership or fiduciary role in Scoliosis Research Society and Setting Scoliosis Straight Foundation (unpaid).","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Review Board of Nemours Office of Human Subject Protection.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":4,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}}]}}