RESUMO
Scoliosis is one of the common diseases in adolescents. It can rapidly progress during the peak growth period. Scoliosis school screening (SSS) is the main way for early detection and treatment of this disease. The SSS project began in the 1960s and was gradually promoted from the United States to the world. However, some problems were gradually exposed during the implementation of the project, such as the high false positive rate of screening methods, potential radiation damage, the uncertainty of the potency ratio of screening and the lack of evidence-based medical evidence of the effectiveness of high-level conservative treatment, which led to many European and American countries stopping the implementation of SSS. However, with the progress of research related to diagnosis and treatment of scoliosis, based on the latest evidence-based medical evidence assessment, the United States Preventive Medicine Task Force again adjusted the recommendation level of SSS to "no recommendation, no objection" in 2018. In recent years, SSS has gradually received extensive attention from the Chinese government and society. Five national ministries and commissions also issued a document in 2021 to include scoliosis in the monitoring of common diseases among students. However, the implementation of the project should also refer to the effectiveness criteria of disease screening recommended by the World Health Organization. In the future, with the improvement of the accuracy of scoliosis screening methods, the development of multi-mode screening such as artificial intelligence, the emergence of non-radiation detection technology and the improvement of the effectiveness of conservative treatment of mild and moderate scoliosis, the long-term and large-scale implementation of SSS project and the early prevention and control of scoliosis will be possible to truly achieve.
RESUMO
Objective To elevate the efficacy and safety of descending neurogenic evoked potentials (DNEP) monitoring during severe rigid spinal deformity surgery.Methods All of 108 patients (43 males,65 females) who underwent surgical treatment for spinal deformity in our spinal center from July 2010 to August 2013 were retrospectively reviewed.The average age (17.5±5.8) ys(range 12-50 ys),the average following period is 38.6 months(range 24-52 months).Combined monitoring of SEP,MEP and DNEP model were used during surgery.All subjects with no neurological deficits preoperatively and got satisfied outcomes.Respectively evaluate the results of neurophysiological intraoperative monitoring (IOM).Data were collected to elevate the efficacy and safety of DNEP monitoring.Results All of 108 patients,15 patients (13.9％,15/108) showed significant changes of neurophysiological parameters,of which 9 cases (60％,9/15) were identified as true positive and 6 cases (40％,6/15) were identified as false positive.During the following-up period,2 patients developed permanent neurological deficit,and 3 patients showed transient neurological deficit who got fully recovered within 6 months after operation.DNEP showed alert in all 5 patients with truepositive alarm,of which 2 patients developed permanent neurological dysfunction and 3 cases showed postoperative short nerve dysfunction that got fully recovery within 6 months after operation.The sensitivity and specificity of SEP+MEP and DNEP were 100％ and 97.98％,100％ and 98.99％,respectively.Conclusion Combining use of MEP+SEP+DNEP monitoring during surgical treatment of spinal deformities presented to be a highly reliable method for the detection and prevention of iatrogenic injury.The results confirmed a high efficacy and safety of DNEP monitoring during spinal surgery.