{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:59:38Z","timestamp":1790189978762,"version":"4.1.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Curve-specific risk factors for intraoperative neuromonitoring (IONM) alerts during surgery for adolescent idiopathic scoliosis (AIS) remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We identified 5,206 patients with AIS who underwent spinal fusion with multimodal IONM from a prospective database. Alerts were defined as \u226550% amplitude decrease in somatosensory evoked potentials (SSEPs) and\/or transcranial motor evoked potentials (TcMEPs), or &gt;10% SSEP latency increase. Demographics, radiographic parameters, surgical variables, triggering events, interventions, and outcomes were compared between the 252 patients with and 4,954 without an alert.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>IONM alerts occurred in 5% of patients. Alert rates varied by Lenke classification, with Type-4 curves demonstrating the highest risk (8%; relative risk [RR] = 1.61, 95% confidence interval [CI], 1.15 to 2.24) and Type 5 demonstrating the lowest risk (2%; RR = 0.45, 95% CI, 0.25 to 0.82). Patients with an alert had a larger mean preoperative major Cobb angle (66.7\u00b0 \u00b1 15.0\u00b0 versus 56.1\u00b0 \u00b1 12.1\u00b0, p &lt; 0.001) and more frequent use of Ponte osteotomies (79% versus 66%, p &lt; 0.001). Multivariable analysis demonstrated the major Cobb angle to be the leading independent risk factor for alerts (p &lt; 0.001). Hypotension was the leading triggering event (23%), and raising blood pressure was the most common intervention overall (52%). Neurologic deficits occurred in 4% of patients with an alert versus &lt;1% of those without an alert (p &lt; 0.001). Only 12 patients (&lt;1%) experienced neurologic deficits, with 2 having permanent deficits. At 2-year follow-up, the major Cobb angle correction did not differ significantly between the groups with and without alerts, alert status did not independently affect correction (p = 0.058), and the groups achieved similar outcomes (73% versus 71% correction, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>IONM alerts occurred in 5% of patients with AIS and were independently associated with a larger major Cobb angle. Fewer than 1% of patients sustained a permanent neurologic injury, and alerts did not appear to compromise 2-year correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.25.01577","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:03:07Z","timestamp":1790186587000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Performance and Clinical Outcomes of Intraoperative Neuromonitoring in Adolescent Idiopathic Scoliosis"],"prefix":"10.2106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8174-931X","authenticated-orcid":false,"given":"Travis S.","family":"CreveCoeur","sequence":"first","affiliation":[{"name":"Shriners Children\u2019s Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4206-610X","authenticated-orcid":false,"given":"Amer F.","family":"Samdani","sequence":"additional","affiliation":[{"name":"Shriners Children\u2019s Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J.","family":"Sch\u00fcpper","sequence":"additional","affiliation":[{"name":"Shriners Children\u2019s Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8475-6822","authenticated-orcid":false,"given":"Terrence G.","family":"Ishmael","sequence":"additional","affiliation":[{"name":"Shriners Children\u2019s Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3023-3660","authenticated-orcid":false,"given":"Firoz","family":"Miyanji","sequence":"additional","affiliation":[{"name":"BC Children\u2019s Hospital, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4885-0138","authenticated-orcid":false,"given":"Suken A.","family":"Shah","sequence":"additional","affiliation":[{"name":"Nemours Children\u2019s Hospital, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baron S.","family":"Lonner","sequence":"additional","affiliation":[{"name":"Mount Sinai Spine Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9236-2284","authenticated-orcid":false,"given":"Burt","family":"Yaszay","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9437-7973","authenticated-orcid":false,"given":"Peter O.","family":"Newton","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8965-354X","authenticated-orcid":false,"given":"Joshua M.","family":"Pahys","sequence":"additional","affiliation":[{"name":"Shriners Children\u2019s Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven W.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Shriners Children\u2019s Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"17","key":"bib1-20260923","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.2106\/JBJS.15.01379","article-title":"Reversible intraoperative neurophysiologic monitoring alerts in patients undergoing arthrodesis for adolescent idiopathic scoliosis: what are the outcomes of surgery?","volume":"98","author":"Samdani","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib2-20260923","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1097\/00007632-200204150-00009","article-title":"Factors related to false- versus true-positive neuromonitoring changes in adolescent idiopathic scoliosis surgery","volume":"27","author":"Noonan","year":"2002","journal-title":"Spine (Phila Pa 1976)."},{"issue":"3","key":"bib3-20260923","doi-asserted-by":"crossref","first-page":"E175","DOI":"10.1097\/BRS.0000000000002784","article-title":"Ponte osteotomies increase the risk of neuromonitoring alerts in adolescent idiopathic scoliosis correction surgery","volume":"44","author":"Buckland","year":"2019","journal-title":"Spine (Phila Pa 1976)."},{"issue":"7","key":"bib4-20260923","doi-asserted-by":"crossref","first-page":"426","DOI":"10.5435\/00124635-200907000-00003","article-title":"Neurologic injury in the surgical treatment of idiopathic scoliosis: 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Spine Deform","volume":"12","author":"Zale","year":"2024"},{"issue":"5","key":"bib14-20260923","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jspd.2014.05.003","article-title":"Best practices in intraoperative neuromonitoring in spine deformity surgery: development of an intraoperative checklist to optimize response","volume":"2","author":"Vitale","year":"2014","journal-title":"Spine Deform."},{"issue":"7","key":"bib15-20260923","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.1177\/21925682241237475","article-title":"Does spinal cord type predict intraoperative neuro-monitoring alerts in scoliosis correction surgery? A systematic review and meta-analysis of operative and radiologic predictors","volume":"14","author":"Al-Naseem","year":"2024","journal-title":"Global Spine J."},{"issue":"11","key":"bib16-20260923","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1016\/j.spinee.2024.06.572","article-title":"Risk predictive score and cord morphology classification for intraoperative neuromonitoring alerts in kyphosis surgery","volume":"24","author":"Rajasekaran","year":"2024","journal-title":"Spine J."},{"issue":"8","key":"bib17-20260923","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.2106\/00004623-200108000-00006","article-title":"Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis","volume":"83","author":"Lenke","year":"2001","journal-title":"J Bone Joint Surg Am."},{"issue":"20","key":"bib18-20260923","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1097\/BRS.0b013e3181d4f532","article-title":"Right thoracic curves in presumed adolescent idiopathic scoliosis: which clinical and radiographic findings correlate with a preoperative abnormal magnetic resonance image?","volume":"35","author":"Richards","year":"2010","journal-title":"Spine (Phila Pa 1976)."},{"issue":"1","key":"bib19-20260923","doi-asserted-by":"crossref","first-page":"14340","DOI":"10.1038\/s41598-024-64971-z","article-title":"In idiopathic scoliosis distances of spinal cord to thoracic pedicle are within 2 mm in a large region of the thoracic apex","volume":"14","author":"Burger","year":"2024","journal-title":"Sci Rep."},{"issue":"8","key":"bib20-20260923","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1177\/21925682241242693","article-title":"Causes of intraoperative neuromonitoring events in adult spine deformity surgery: a systematic review","volume":"14","author":"Cottone","year":"2024","journal-title":"Global Spine J."},{"issue":"1","key":"bib21-20260923","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1302\/2058-5241.5.180032","article-title":"Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues - surgeons\u2019 views","volume":"5","author":"Biscevic","year":"2020","journal-title":"EFORT Open Rev."},{"issue":"4","key":"bib22-20260923","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s43390-022-00485-w","article-title":"Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery","volume":"10","author":"Lenke","year":"2022","journal-title":"Spine Deform."},{"issue":"24","key":"bib23-20260923","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1097\/BRS.0b013e31815a5970","article-title":"Neural complications in the surgical treatment of adolescent idiopathic scoliosis","volume":"32","author":"Diab","year":"2007","journal-title":"Spine (Phila Pa 1976)."},{"key":"bib24-20260923","doi-asserted-by":"crossref","first-page":"154","DOI":"10.25259\/SNI_67_2022","article-title":"Ponte osteotomies increase risk of intraoperative neuromonitoring alerts in adolescent idiopathic scoliosis surgery","volume":"13","author":"Harfouch","year":"2022","journal-title":"Surg Neurol Int."},{"key":"bib25-20260923","first-page":"e925371","article-title":"A retrospective study of surgical correction for spinal deformity with and without osteotomy to compare outcome using intraoperative neurophysiological monitoring with evoked potentials","volume":"26","author":"Chen","year":"2020","journal-title":"Med Sci Monit."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01577","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:03:11Z","timestamp":1790186591000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01577"}},"subtitle":["A Comprehensive Analysis of 5,206 Patients"],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":25,"URL":"https:\/\/doi.org\/10.2106\/jbjs.25.01577","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]}}}