Diagnostic Accuracy of Combined Multimodality Somatosensory Evoked Potential and Transcranial Motor Evoked Potential Intraoperative Monitoring in Patients With Idiopathic Scoliosis

Thirumala, Parthasarathy D.; Huang, Jessie; Thiagarajan, Karthy; Cheng, Hannah; Balzer, Jeffrey; Crammond, Donald J.

doi:10.1097/brs.0000000000001678

Cited by 61 publications

(41 citation statements)

References 25 publications

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“…Stabilizing the hemodynamic status resulted in recovery of TcMEPs. A new postoperative neurological deficit was only seen in one surgery with INM (1.6%), in one child of 56 (1.8%): this is similar to the 1.38% deficit reported in a systematic review of the diagnostic accuracy of motor evoked potentials to detect neurological deficits during idiopathic scoliosis correction ( Thirumala et al, 2017 , Thirumala et al, 2016 ). There were no new neurological deficits without an alert during INM and other studies ( Ferguson et al, 2014 ) have also suggested that INM has a 100% negative predictive value.…”

Section: Discussionsupporting

confidence: 80%

“…We undertook 61 INMs with TcMEPs and SSEPs in 56 children having scoliosis and spine deformity surgery, with no adverse effects from the INM. TcMEP is a highly sensitive and specific tool for detecting spinal cord motor impairment or injury during spine surgery ( Kim et al, 2013 , Legatt et al, 2016 , Thirumala et al, 2016 , Thirumala et al, 2017 , Kelleher et al, 2008 ). Previous studies ( Legatt et al, 2016 ) have reported predominantly minor injuries in <0.2% of patients having INM.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative neurophysiology monitoring in scoliosis surgery in children

Nagarajan

Ghosh

Dillon

et al. 2019

Clinical Neurophysiology Practice

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Intraoperative neurophysiology monitoring in scoliosis surgery in children

Nagarajan

Ghosh

Dillon

et al. 2019

Clinical Neurophysiology Practice

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“…[ 4 , 5 , 12 – 14 ] Surgery for SBFD remains technically demanding due to the potential risk of postoperative neurological deterioration such as sensory loss, lower limb weakness, and even paralysis. At present, MIOM has been widely utilized to prevent neurological compromise in scoliosis correction [ 15 ] and intramedullary tumor resection surgery. [ 16 , 17 ] MIOM data has been trusted by various authors.…”

Section: Discussionmentioning

confidence: 99%

“…[ 16 , 17 ] MIOM data has been trusted by various authors. [ 8 , 9 , 15 – 19 ] However, no studies have focused on the intraoperative spinal cord function detected by MIOM during the reduction of the fracture and dislocation. Therefore, the present study was conducted to estimate the feasibility of MIOM on SBFD patients in PRI surgery.…”

Section: Discussionmentioning

confidence: 99%

Multimodal intraoperative monitoring during reduction of spine burst fracture and dislocation prevents neurologic injury

Wang²,

Zhang

et al. 2018

Medicine

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This study aims to evaluate the application of multimodal intraoperative monitoring (MIOM) in surgical treatment for spine burst fracture and dislocation (SBFD) patients.Eleven patients who underwent posterior reduction and instrumentation (PRI) for SBFD from June 2014 to July 2016 were included into the study. The function of the spinal cord was monitored by MIOM. The muscle strength of the lower extremities and American Spinal Injury Association (ASIA) scores were, respectively, evaluated (before surgery, and at 1, 3, 6, and 12 months after surgery). Furthermore, the extent of reduction was also assessed.Muscle strength recovery, ASIA score changes, and the extent of reduction were correlated with MIOM results. Among the 11 patients who received surgery under MIOM, 8 patients with negative MIOM results during the operation did not demonstrate neurological deterioration postoperatively and exhibited improvements in ASIA scores during follow-ups. However, among the 3 patients who encountered MIOM events (case 4, 7, and 8), 2 patients avoided nerve lesion and 1 patient suffered from neurologic deterioration postoperatively.The application of MIOM technology during PRI surgery may detect spinal cord impairment at the early stage, and operative schemes can be modified before permanent nerve compromise is triggered by surgical manipulation.

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“…Contraindications mainly include (1) L5-S1 lumbar disc herniation due to the high ilium which affects the installation of the channel, 2 INM has been commonly utilized to avoid nerve damage in spinal surgery [9,19], and considered by many scholars as a reliable method to avoid nerve injury [9,19,20]. Even if there are no neuromonitoring events during the operation, we believe that it is necessary to monitor the functional state of the nerve root, especially in the process of channel installation.…”

Section: Indications Of This Technique Include (1) Ldh With Segmentalmentioning

confidence: 99%

Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion under intraoperative neuromonitoring: a technique note report

Zhang

et al. 2019

Preprint

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KEYWORDS 2 endoscopic, lumbar intervertebral fusion, lumbar disc herniation, percutaneous, minimally invasive 3 Abstract Abstract Background: Open discectomy and intervertebral fusion surgery, including posterior lumbar intervertebral fusion (PLIF), anterior lumbar intervertebral fusion (ALIF), oblique lateral lumbar intervertebral fusion (OLIF), transforaminal lumbar intervertebral fusion (TLIF), and direct lateral lumbar intervertebral fusion (DLIF), are the common strategies for lumbar disc herniation (LDH), but they require quite a long recovery period. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF) has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays, and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH. Methods: a 51-year-old male with left lower extremity pain and numbness for 1 year was diagnosed with lumbar disc herniation (LDH). This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin's triangle. Each step of the operation was performed under INM. Results: The follow-up period lasted 1 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 minutes. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, nonunion, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively. Conclusion: ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar's exiting nerve root directly with minimal invasion in selected patients.Although it is theoretically safe, INM is carried out to prevent nerve injury.Indications of this technique include (1) LDH with segmental instability, (2) lumbar spinal stenosis with segmental instability and (3) lumbar spondylolisthesis of lower than Meyerding grade II.Contraindications mainly include (1) L5-S1 lumbar disc herniation due to the high ilium which affects the installation of the channel, (2) variation of the nerve root, (3) lumbar spondylolisthesis of higher than Meyerding grade III, and (4) severe central canal stenosis.Advantages of ZELIF include shorter operation time, less blood loss, shorter hospital stays, a very low risk for pulmonary embolism, less soft tissue destruction, less pain, quicker restoring the function of s...

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Diagnostic Accuracy of Combined Multimodality Somatosensory Evoked Potential and Transcranial Motor Evoked Potential Intraoperative Monitoring in Patients With Idiopathic Scoliosis

Abstract: 2.

Cited by 61 publications

References 25 publications

Intraoperative neurophysiology monitoring in scoliosis surgery in children

Intraoperative neurophysiology monitoring in scoliosis surgery in children

Multimodal intraoperative monitoring during reduction of spine burst fracture and dislocation prevents neurologic injury

Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion under intraoperative neuromonitoring: a technique note report

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