Anterior spinal cord injury with preserved neurogenic ‘motor’ evoked potentials

Minahan, Robert E.; Sepkuty, Jehuda P.; Lesser, Ronald P.; Sponseller, Paul D.; Kostuik, John P.

doi:10.1016/s1388-2457(01)00567-3

Cited by 165 publications

(42 citation statements)

References 29 publications

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“…SSEP recording is not of much use in detecting and preventing a procedure-related motor deficit. In recent years, intraoperative spinal eMEP recording has proven very valuable in spinal cord tumor surgery because it allows monitoring of D waves and the intraoperative decrease in its amplitude (41,50). The major advantage of combined mMEP and eMEP monitoring is that it identifies impairment of the functional integrity of the motor pathways before a permanent deficit has occurred (38,40,41,70).…”

Section: Ionmmentioning

confidence: 99%

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

Groen

Middel

Meilof

et al. 2009

Operative Neurosurgery

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Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. METHODS: An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. RESULTS: Brown-Séquard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P Ͻ 0.036). CONCLUSION: Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Séquard syndrome have a better prognosis with respect to postoperative motor function improvement. In this review, spinal cord release and subsequent widening of the dura defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder.

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Section: Ionmmentioning

confidence: 99%

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

Groen

Middel

Meilof

et al. 2009

Operative Neurosurgery

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“…For example, ''neurogenic MEPs'' peripheral nerve potentials evoked by spinal cord stimulation turned out not to be motor [8,20,35]. Nevertheless, terminology established by the International Federation of Clinical Neurophysiology (IFCN), American Clinical Neurophysiology Society (ACNS) and American Society of Neurophysiologic Monitoring (ASNM) is accurate, widely applied and acceptable [1,4,16,34].…”

Section: Miom Rationale and Nomenclaturementioning

confidence: 99%

Current opinions and recommendations on multimodal intraoperative monitoring during spine surgeries

et al. 2007

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“…With a spinal cord stimulation technique, it is not possible to determine laterality of the response. In addition, another and perhaps more important reason is the evidence that has indicated that NMEP are not mediated by motor pathways but instead by antidromic conduction in sensory pathways and therefore are not a motor response at all [ 6,26 ] . Today transcranial electrical stimulation is the standard method used to generate an MEP response.…”

Section: Technical Aspects Of Mep Monitoringmentioning

confidence: 99%

“…Thus MEP monitoring has been embraced by spine and neurological surgeons as a method to help prevent surgical intervention from exceeding safe limits where risk and severity of the potential surgical injury exceeds the functional gain [ 3 ] . Since MEP monitoring, particularly in spinal surgery, has a better correlation with good postoperative motor outcome than the use of SEPs, many experts advocate MEP monitoring for all surgeries (1) surgical correction of axial skeletal deformity [4][5][6][7] , (2) intramedullary spinal cord tumors [8][9][10][11] , (3) intracranial tumors [12][13][14] , and (4) CNS vascular lesions [15][16][17] . Uses of MEPs continue to expand.…”

mentioning

confidence: 99%

Transcranial Motor Evoked Potentials

Jameson

2011

Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

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Motor-evoked potentials (MEPs) are the most recent addition to routine intraoperative neurophysiologic monitoring (IOM). Enthusiastic reports of improved outcomes obtained with the use of somatosenory evoked potential (SEP) monitoring, primarily for scoliosis procedures in children and young adults, were quickly followed by case reports of isolated postoperative motor injury without sensory changes [ 1 ] . These reports reflected the reality of the anatomy and physiology of motor/sensory pathways. MEP and SEP pathways are located in different topographic and vascular regions of the cerebral cortex, brainstem, and spinal cord. Motor functional pathways are more sensitive to ischemic insults than SEP pathways [ 2 ] .

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Anterior spinal cord injury with preserved neurogenic ‘motor’ evoked potentials

Cited by 165 publications

References 29 publications

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

Current opinions and recommendations on multimodal intraoperative monitoring during spine surgeries

Transcranial Motor Evoked Potentials

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