Importance of Intraoperative Neuromonitoring for Corrective Surgery in Patients with Adolescent Idiopathic Scoliosis

<b>Background:</b> Intraoperative neurophysiological monitoring (IONM) has become an invaluable tool for spinal deformity surgery. This study aims to present our experience of using transcranial motor evoked potential (Tc-MEP) as an IONM tool in adolescent idiopathic scoliosis patients undergoing navigation-assisted deformity correction and explore the potential risk factors associated with false-positive and true-positive IONM findings. <b>Methods:</b> A retrospective study was conducted in 103 patients (mean age 16.2 ± 4.0 years) undergoing corrective surgery for spinal deformity. All pediatric spinal deformity correction surgeries at the center were performed by a single senior spine surgeon, utilizing navigation and Tc-MEP to enhance the neurological safety profile. The sensitivity and the specificity of Tc-MEP were calculated. <b>Results:</b> Of the total cases, 87 patients (84.5%) exhibited no IONM signal alert and did not experience any postoperative neurological deficits, representing true negatives. There were no false-negative cases, which gives a negative predictive value of 100%. Significant IONM signal alerts were observed in 16 patients (15.5%), but only two patients (1.9%) experienced a postoperative motor deficit, representing true positives, which yielded a positive predictive value of 12.5%. <b>Conclusions:</b> This study demonstrated the sensitivity and specificity of Tc-MEP to be 100% and 86.3%, respectively, with a false-positive rate of 13.7%. Blood loss was the only factor significantly associated with IONM alerts, while age, gender, surgical duration, and anesthetic modality showed no significant differences.