A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research

Kobayashi, Sho; Matsuyama, Yukihiro; Shinomiya, Kenichi; Kawabata, Shigenori; Ando, Muneharu; Kanchiku, Tsukasa; Saito, Takanori; Takahashi, Masahito; Ito, Zenya; Muramoto, Akio; Fujiwara, Yasushi; Kida, Kenji; Yamada, Kei; Wada, Kanichiro; Yamamoto, Naoya; Satomi, Kazuhiko; Tani, Tohru

doi:10.3171/2013.10.spine12944

Cited by 115 publications

(108 citation statements)

References 16 publications

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“…An overly conservative (specific) MEP alert criterion may not be sufficiently sensitive during some cranial and spinal surgeries. In this instance, an opportunity to intervene may be missed and a new postoperative deficit may result (Zhou and Kelly, 2001;Dong et al, 2005;Kobayashi et al, 2014). On the other hand, an overly sensitive criterion for some procedures could produce too many false alarms and compromise surgical treatment, resulting in incomplete tumor removal or suboptimal deformity correction.…”

Section: Utilization: In What Context Are Eps Used?mentioning

confidence: 94%

“…Thirumala et al (2014) examined SEP performance in a large retrospective series of surgeries for idiopathic scoliosis. Kobayashi et al (2014) examined MEP performance during spine surgeries with diverse patient diagnoses. They recognized that the neurological status of the patient during a RSC is unknown, and the initial decline could be either a true or false positive.…”

Section: Causal Linksmentioning

confidence: 99%

“…The multi-center study by Kobayashi et al (2014) examined MEPs in 959 patients with diverse diagnoses which included spinal deformity and extra-and intra-medullary tumors. They avoided the bias introduced by RSCs to diagnostic statistics by omitting them from the analysis as ''indeterminate (rescue)'' cases, an approach also taken by Kim et al (2007).…”

Section: Causal Linksmentioning

confidence: 99%

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Somatosensory and motor evoked potentials as biomarkers for post-operative neurological status

Holdefer¹,

MacDonald²,

Skinner³

2015

Clinical Neurophysiology

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Section: Utilization: In What Context Are Eps Used?mentioning

confidence: 94%

Section: Causal Linksmentioning

confidence: 99%

Section: Causal Linksmentioning

confidence: 99%

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Somatosensory and motor evoked potentials as biomarkers for post-operative neurological status

Holdefer¹,

MacDonald²,

Skinner³

2015

Clinical Neurophysiology

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“…Tamaki et al 4 reported that six patients experienced postoperative neurologic complications, and that, in these patients, the peak amplitudes of the SCEPs diminished to less than 50% of the control values. Recently, Kobayashi et al 5 recommended the designation of an alarm point at a 70% decrease in TcMEPs amplitude for routine spinal cord monitoring. In accordance with those reports, we usually conduct spinal surgery using TcMEPs with an alarm point of less than 30% of the amplitude of the control values.…”

Section: Discussionmentioning

confidence: 99%

Resection of spinous processes can cause spinal cord injury in patient with ossification of the posterior longitudinal ligament in the thoracic spine

et al. 2014

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Study design: Case report. Objective: To report intraoperative spinal cord injury by resection of spinous processes in a 73-year-old man with ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Methods: A 73-year-old man presented with cervicothoracic OPLL with bilateral numbness and clumsiness of his hand, weakness of his lower extremities and severe gait disturbance. His Japanese Orthopaedic Association (JOA) score was 7.5 out of 17. Cervical laminoplasty (C2-6), cervicothoracic laminectomy (C7-T10) and posterior fusion (C7-T10) were performed in the prone position with electrophysiologic monitoring of the spinal cord-evoked potentials (SCEPs). Results: The spinal processes with supra-and interspinous ligaments between C7 and T10 were resected. After resection, the amplitude of SCEP waveforms decreased rapidly to o10% of control levels. Laminectomy was performed, and, after 80 min of SCEP deterioration, an instrumented fusion with correction for kyphosis was completed. The SCEP amplitude recovered gradually. Immediately after surgery, the patient suffered severe motor loss in both lower limbs. His neurological recovery progressed gradually from 2 days after surgery, and he was able to walk at 3 months after surgery. At 6 years after surgery, the JOA score was 11. Conclusion: Our results suggest that intraoperative spinal cord injury can occur before posterior decompression by resection of spinal processes with supra-and interspinous ligaments. The timing of the instrumented stabilization using a temporary rod is important and should be considered immediately after posterior exposure of the spine. Spinal Cord (2014) 52, S19-S21; doi:10.1038/sc.2014.151 INTRODUCTIONIn treatment for thoracic ossification of the posterior longitudinal ligament (OPLL), postoperative paraplegia is a major risk. 1,2 To avoid the postoperative paraplegia, posterior decompression with instrumented fusion (PDF) has been reported. 3 However, postoperative paraplegia remains a risk and the causes are controversial. We present a case of cervicothoracic OPLL suggesting that electrophysiologic monitoring can be used to document the occurrence of paralysis with resection of spinous processes. CASE REPORTA 73-year-old man presented with cervicothoracic OPLL, a Japanese Orthopaedic Association (JOA) score for cervical myelopathy of 7.5 (17 points is full points) and JOA score for thoracic myelopathy of 5.5 (11 points is full points). The patient complained of bilateral numbness, clumsiness of his hands, bilateral motor weakness of his lower extremities (manual muscle testing: MMT at grade 4 out of 5), hypoesthesia in both lower limbs (Grade 1-5 out of 10) and inability to walk without a handrail. Reconstructed images from a computerized tomography (CT) myelogram showed extensive segmental OPLL, in particular at C4-5 (Figure 1a), T2-3 and T7-8 levels (Figure 1b). Thoracic MRI showed severe compression of the spinal cord at T2-3 and T7-8 (Figure 1c). The kyphotic Cobb's angle between the upper endplate of the C7 an...

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“…18 Some criteria exist, such as decreased amplitude by 50%, 70%, 80%, or even 88%. 11,[19][20][21] It was reported that the risk of MEP deterioration was higher in patients with preoperative spinal deficits than in normal patients. 11 Taher …”

Section: Deteriorated Signals and The Achievement Of The "Alarm Pointmentioning

confidence: 99%

Progress in Intraoperative Neurophysiological Monitoring for the Surgical Treatment of Thoracic Spinal Stenosis

Liu¹,

Zhao²

2017

Chinese Medical Sciences Journal

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Thoracic spinal stenosis (TSS) is a group of clinical syndromes caused by thoracic spinal cord compression, which always results in severe clinical complications. The incidence of TSS is relatively low compared with lumbar spinal stenosis, while the incidence of spinal cord injury during thoracic decompression is relatively high. The reported incidence of neurological deficits after thoracic decompression reached 13.9%. Intraoperative neurophysiological monitoring (IONM) can timely provide information regarding the function status of the spinal cord, and help surgeons with appropriate performance during operation. This article illustrates the theoretical basis of applying IONM in thoracic decompression surgery, and elaborates on the relationship between signal changes in IONM and postoperative neurological function recovery of the spinal cord. It also introduces updated information in multimodality IONM, the factors influencing evoked potentials, and remedial measures to improve the prognosis. should be alert to the existence of false-negative tests during thoracic decompression surgery, and endeavor to achieve timely detection and appropriate treatment. Deteriorated signals and the achievement of the "alarm point" during the operationThe present criterion for an abnormal SEP, namely a 50% decrease in amplitude and/or a 10% increase in latency, has been widely used in the surgical treatment of TSS. 14,16 In the study by Taher Multimodality intraoperative monitoring (MIOM)SEP is a method of monitoring the sensory pathway, and it cannot directly monitor the motor conduction pathway in the anterior column of the spinal cord. This is the basic cause of false-negative SEP monitoring. Factors influencing evoked potentialsThe intraoperative signal changes are mainly caused by factors related to anesthesia, physiology and surgery. If no significant signal recovery after these treatments, Stagnara wake-up test and shock therapy using methylprednisolone are suggested. Shock therapy involves an initial bolus of 30 mg/kg of methylprednisolone followed by an infusion of 5.4 mg/kg/h for 23 hours. 35 Methylprednisolone therapy should be maintained till the end of the surgery.After the surgery, whether to apply the drug continuously or to change to other rehabilitation treatments depends on the recovery status from the postoperative neurological functional evaluation. Summary and prospectsIn summary, the application of IONM during thoracic

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A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research

Cited by 115 publications

References 16 publications

Somatosensory and motor evoked potentials as biomarkers for post-operative neurological status

Somatosensory and motor evoked potentials as biomarkers for post-operative neurological status

Resection of spinous processes can cause spinal cord injury in patient with ossification of the posterior longitudinal ligament in the thoracic spine

Progress in Intraoperative Neurophysiological Monitoring for the Surgical Treatment of Thoracic Spinal Stenosis

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