{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:02:04Z","timestamp":1790650924146,"version":"4.1.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Key Research and Development Program of China","award":["2023YFC2507702"],"award-info":[{"award-number":["2023YFC2507702"]}]},{"DOI":"10.13039\/501100001809","name":"National Nature Science Foundation of China","doi-asserted-by":"crossref","award":["82472789"],"award-info":[{"award-number":["82472789"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Yunnan Province Science\/Technology Talent and Platform Plan Project","award":["202205AF150062"],"award-info":[{"award-number":["202205AF150062"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Intraoperative neurophysiological monitoring (IONM) is crucial for detecting impending iatrogenic neurological injury during high-risk scoliosis surgery. However, the implication of significant IONM alarms on long-term neurological function remains unknown for complex deformity correction. This study aims to report the longitudinal neurological outcomes and identify predictors of long-term neurological survivorship for patients with severe spinal deformities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 115 patients who encountered significant intraoperative neuromonitoring alarms (excluding systematic and non-operative confounders) during high-risk surgical maneuvers were analyzed. A longitudinal clinical dataset containing baseline information, surgical details, multimodal IONM data, and follow-up neurological function was collected. Cox regression analysis was performed to identify prognostic factors that could predict long-term neurological survivorship. Kaplan-Meier curves were plotted for these predictors, and a nomogram facilitated the clinical prediction of 2-year neurological function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Immediately after surgery, 57 patients (49.6%) showed neurological deficits, which decreased to only 5 cases (4.3%) at the 2-year follow-up. Multivariate Cox regression analysis for long-term neurological survivorship identified decreased hazard ratios (HRs) for grade six osteotomy (HR, 0.311;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.028), a positive wake-up test (HR, 0.216;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and no recovery of descending neurogenic evoked potentials (DNEPs) (HR, 0.162;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). A nomogram based on osteotomy grade, wake-up test, and DNEP recovery status was established to predict 2-year neurological function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, patients with severe spinal deformities who experienced significant IONM alarms demonstrated gradual neurological improvement over the 2-year follow-up. Osteotomy grade, wake-up test results, and DNEP recovery status were identified as valuable predictors that could facilitate surgical decision-making, prognostication, and counseling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682251403544","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T04:16:07Z","timestamp":1764044167000},"page":"2242-2251","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Neurological Outcomes Following Significant Intraoperative Neuromonitoring Alarms: A Longitudinal Study of 115 Patients With Severe Spinal Deformities"],"prefix":"10.1177","volume":"16","author":[{"given":"Yaolong","family":"Deng","sequence":"first","affiliation":[{"name":"Xinhua Hospital Affiliated to Shanghai Jiaotong University School of 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