A new criterion for detection of radiculopathy based on motor evoked potentials and intraoperative nerve root monitoring

Traba, A.; Romero, Juan Pablo; Arranz, Beatriz Arranz; Vilela, Concepción

doi:10.1016/j.clinph.2018.07.005

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Additionally, if SSEP and EMG are monitored at the same time, SSEP interferes with EMG, making the EMG results difficult to interpret. Therefore, studies have suggested combining MEP and EMG to monitor lumbar surgery [ 6 , 29 , 36 – 38 ], but in our study, there was one case with only SSEP changing, resulting in the development of numbness and tingling in the anterior thighs. These results suggest that monitoring with SSEP better monitors the sensory function of the nervous system during surgery.…”

Section: Discussionmentioning

confidence: 71%

“…The alarm standard set by our research included an amplitude drop greater than 80%, and some were greater than 50% [ 28 ]. Moreover, a 70% decrease in the MEP area was previously used as a criterion for warning in IONM [ 29 ]. However, which standard should be used for endoscopic lumbar inter-body fusion surgery requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

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Roles of multimodal intra-operative neurophysiological monitoring (IONM) in percutaneous endoscopic transforaminal lumbar interbody fusion: a case series of 113 patients

Luo

Wang

Liu

et al. 2021

BMC Musculoskelet Disord

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Background Despite the wide use of intraoperative neurophysiological monitoring (IONM) in spinal surgeries, the efficacy of IONM during percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) surgery in detecting postoperative neurological deficits has not been well characterized. Methods MIONM data from 113 consecutive patients who underwent PE-TLIF surgeries between June 2018 and April 2020 were retrospectively reviewed. Postoperative neurological deficits were documented and analyzed, and the efficacy and specificity of various IONM techniques were compared. Results Of the 113 consecutive patients, 12 (10.6%) with IONM alerts were identified. The MIONM sensitivity and specificity were 100 and 96.2%, respectively. The frequency of neurological complications, including minor deficits, was 6.2% (n = 7); all of the neurological complications were temporary. The ability of single IONM modalities to detect neurological complications varied between 25.0 and 66.6%, whereas that of all modalities was 100%. Conclusions MIONM is more effective and accurate than unimodal monitoring in assessing nerve root function during PE-TLIF surgeries, reducing both neurological complications and false-negative findings. We recommend MIONM in PE-TLIF surgeries.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Roles of multimodal intra-operative neurophysiological monitoring (IONM) in percutaneous endoscopic transforaminal lumbar interbody fusion: a case series of 113 patients

Luo

Wang

Liu

et al. 2021

BMC Musculoskelet Disord

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“…Число ложноположительных результатов достаточно велико, что ставит под сомнение достоверность принятых в нейрофизиологическом сообществе критериев [5]. По наблюдениям зарубежных авторов, в ряде случаев при оперативных вмешательствах у пациентов с цервикальной миелопатией при падении амплитуды МВП на 80 % не наблюдалось неврологического дефицита в послеоперационном периоде, что говорит о низкой информативности данной модальности как предиктора развития неврологического дефицита [6,7].…”

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Prognostic significance of motor evoked potentials in surgical interventions to eliminate spinal stenosis at the cervical level

Яковлева

Kanshina

Подгурская

et al. 2020

Neuromuscular Diseases

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Introduction. Transcranial electrical stimulation is a neurophysiological method that is used intraoperatively for evaluating the conduct of a nerve impulse through the cortical-spinal tract. However, the results obtained during registration of this modality do not always correlate with the neurological status of the patient after surgery. The purpose of the study is to determine the prognostic significance of motor evoked potentials in surgical interventions for the elimination of spinal stenosis at the cervical level. Materials and methods. The study analyzed the results of 20 microsurgical root decompressions at the cervical level by eliminating spinal stenosis. Surgical interventions were performed in the neurosurgical Department of National medical and surgical center named after N.I. Pirogov from august 2018 to march 2019. Intraoperatively there were used the following modalities: motor evoked potentials, 3-channel registration of somatosensory evoked potentials from the median nerves, 8-channel electroencephalography, and train-of-four monitoring. The patients were divided into 2 groups: in the 1st group was used inhalant anesthetics, in the 2nd the anesthesia was conducted according to the protocol “Total intravenous anesthesia”. Results. Within each group, in a number of cases, there was a decrease in the response amplitude (by 80 % or more), as well as a loss of motor evoked potentials. In the “Total intravenous anesthesia” group, the current stimulation forces used to obtain motor evoked potentials did not exceed 150 mA, while in the group of inhaled anesthetics, the maximum value was 300 mA, and the average value was 170 mA. In the “Total intravenous anesthesia” group, in 2 cases, a loss of response from one myotome at the decompression phase was registered without recovery during intraoperation monitoring, in 2 cases there was the amplitude loss by 80 % or more with subsequent recovery. In the “Total intravenous anesthesia” group, the results were comparable. Conclusion. During neurophysiological monitoring in surgeries at the cervical level, the loss of motor evoked potentials from one myotome, as well as a decrease the response amplitude by 80 % or more are doubtful as a criteria for predicting neurological deficit.

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Trending algorithm discriminates hemodynamic from injury related TcMEP amplitude loss

Jasiukaitis¹,

Lyon

2019

J Clin Monit Comput

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A new criterion for detection of radiculopathy based on motor evoked potentials and intraoperative nerve root monitoring

Abstract: The criterion of decrease of the MEP area has a higher reliability and accuracy in the detection of intraoperative radicular lesions than the amplitude reduction.

Cited by 5 publications

References 22 publications

Roles of multimodal intra-operative neurophysiological monitoring (IONM) in percutaneous endoscopic transforaminal lumbar interbody fusion: a case series of 113 patients

Roles of multimodal intra-operative neurophysiological monitoring (IONM) in percutaneous endoscopic transforaminal lumbar interbody fusion: a case series of 113 patients

Prognostic significance of motor evoked potentials in surgical interventions to eliminate spinal stenosis at the cervical level

Trending algorithm discriminates hemodynamic from injury related TcMEP amplitude loss

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