Spinal Deformity Intraoperative Monitoring.

NCT ID: NCT03880292

Last Updated: 2022-11-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

569 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-05-15

Study Completion Date

2022-11-01

Brief Summary

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A multicenter, international prospectively collected patient cohort undergoing high-risk spinal cord level surgery or spinal osteotomy procedures will be enrolled to establish the incidence of intraoperative alerts in high-risk spinal cord cases, and explore factors associated with mitigating injury. Baseline, intraoperative, and postoperative characteristics, including demographics, radiological features, lower extremity motor score (LEMS), procedure, anesthetic agents used, and baseline blood pressure will be recorded for either adult patients or pediatric patients.

Detailed Description

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A multicenter, international prospectively collected patient cohort undergoing high-risk spinal cord level surgery or spinal osteotomy procedures will be enrolled to establish the incidence of intraoperative alerts in high-risk spinal cord cases, and explore factors associated with mitigating injury. Baseline, intraoperative, and postoperative characteristics, including demographics, radiological features, lower extremity motor score (LEMS), procedure, anesthetic agents used, and baseline blood pressure will be recorded for either adult patients or pediatric patients.

If a major change occurs in the intraoperative neuromonitoring, defined as a loss of amplitude greater than 50% in the MEP or SSEP from baseline or sustained EMG activity, a separate form (Appendix 3, Intraoperative Alert Form) will be completed in real-time by the neuromonitoring technician outlining the timing of the alert, blood pressure at the time, surgical events at the time of the change, intraoperative maneuvers performed to address the change, and resultant outcome of these maneuvers to address the neuromonitoring change. For each alert occurring during the procedure, a separate form will be completed.

Once the patient is awake from anesthesia, the treating surgeon will perform a neurological examination to identify details about the deficit including sidedness, LEMS, sensory deficit, injury to the nerve root, incomplete spinal cord (ie anterior cord, posterior cord, central cord, Brown-Sequard), complete spinal cord injury, conus or cauda equina deficit. The examination is repeated on the day of discharge from hospital, or at day 30, whichever comes first and documented in the corresponding form.

The objective of this study is to identify the incidence of intraoperative alerts in high-risk spinal cord cases, correlate significant neuromonitoring changes to intraoperative events, and identify maneuvers that will restore the neuromonitoring changes to baseline. The information provided by this study will educate spinal surgeons to recognize a spinal cord at risk and to perform intraoperative maneuvers that will decrease the incidence of neurological injuries.

Conditions

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Spinal Deformity

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Intraoperative Maneuvers

To document intraoperative maneuvers performed in repsonse to alerts

Group Type OTHER

Document intraoperative Maneuvers

Intervention Type PROCEDURE

Monitoring procedure during surgery

Interventions

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Document intraoperative Maneuvers

Monitoring procedure during surgery

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age \>10 years to \<80 years
* Neurologically intact spinal cord (with or without radiculopathy)
* Undergoing primary or revision procedure in the spine
* Anterior and/or posterior surgical approach for any of the following:

* Correction of spinal deformity with a major Cobb angle of ≥ 80° in the coronal or sagittal plane
* Correction of high grade spondylolisthesis (Grades 3- 5)
* Posterior column or 3-column osteotomy
* Requiring multimodal neuromonitoring with EMG, SSEP, and MEP as per standard of care
* Informed consent obtained for patients i.e.:

* Ability to understand the content of the patient information
* Willingness and ability to participate in the clinical investigation according to the Clinical Investigation Plan (CIP)
* Signed and dated EC/IRB approved written informed consent OR
* Written consent obtained according to defined and IRB/EC approved procedures for patients who are not able to provide independent written informed consent

Exclusion Criteria

* Upper motor neuron lesion
* Growing rods or growth guidance procedures
* Tether or staple procedures
* Stand-alone cervical deformity correction procedures
* Any not medically managed severe systemic disease
* Recent history of substance abuse (ie recreational drugs, alcohol) that would preclude reliable assessment
* Pregnancy or women planning to conceive within the study period
* Prisoner
* Participation in any other medical device or medicinal product study that could influence the results of the present study
Minimum Eligible Age

10 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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AO Foundation, AO Spine

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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UC San Franciisco

San Francisco, California, United States

Site Status

University of Minnesota

Minneapolis, Minnesota, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

Duke University Medical Center

Durham, North Carolina, United States

Site Status

University of Virginia

Charlottesville, Virginia, United States

Site Status

Royal North Shore Hospital

Saint Leonards, , Australia

Site Status

Hospital Infantil Joana de Gusmão

Florianópolis, , Brazil

Site Status

Hospital das clinicas de São Paulo e AACD

São Paulo, , Brazil

Site Status

Shriners Hospital for Children

Montreal, , Canada

Site Status

Montreal General Hospital

Montreal, , Canada

Site Status

Toronto Western Hospital

Toronto, , Canada

Site Status

Nanjing Drum Tower Hospital

Nanjing, , China

Site Status

Queen Mary Hospital

Hong Kong, , Hong Kong

Site Status

Mallika Spine Centre

Guntur, , India

Site Status

Kothari Medical Centre

Kolkata, , India

Site Status

Tel Aviv Medical Center - Dana Children's Hospital

Tel Aviv, , Israel

Site Status

Hamamatsu University School of Medicine

Hamamatsu, , Japan

Site Status

University Medical Center St. Radboud

Nijmegen, , Netherlands

Site Status

Ghurki Trust Teaching Hospital

Lahore, , Pakistan

Site Status

Hospital Vall d'Helbron

Barcelona, , Spain

Site Status

Acibadem Maslak Hospital

Istanbul, , Turkey (Türkiye)

Site Status

Guys Hospital

London, , United Kingdom

Site Status

Salford Royal Hospital

Manchester, , United Kingdom

Site Status

Nottingham Queens Medical Centre

Nottingham, , United Kingdom

Site Status

Countries

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United States Australia Brazil Canada China Hong Kong India Israel Japan Netherlands Pakistan Spain Turkey (Türkiye) United Kingdom

Other Identifiers

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SDIM

Identifier Type: -

Identifier Source: org_study_id

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