Efficacy of Biphasic Transcranial Electric Stimulation in Intraoperative Motor Evoked Potential Monitoring for Cervical Compression Myelopathy

Ukegawa, Dai; Kawabata, Shigenori; Sakaki, Kyohei; Ishii, Shigeaki; Tomizawa, Shoji; Inose, Hiroyuki; Yoshii, Toshitaka; Kato, Tsuyoshi; Enomoto, Mitsuhiro; Okawa, Atsushi

doi:10.1097/brs.0000000000000082

Cited by 14 publications

(8 citation statements)

References 19 publications

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“…At present, there have been lots of studies concerning the application of transcranial motor evoked potential (MEP) to cervical spine surgery, including the value of predicting postoperative neurological deficits 1,2 ; the optimal mode of electric stimulation 3 , and warning thresholds 4 and others. On the contrary, some controversies regarding the intraoperative monitoring also present in cervical surgery, including high false positive rate, 5 low efficiency 6,7 , and lack of reliable warning criteria for CCM.…”

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confidence: 99%

Exploration of the Intraoperative Motor Evoked Potential

Wang

Tian²

2016

SPINE

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confidence: 99%

Exploration of the Intraoperative Motor Evoked Potential

Wang

Tian²

2016

SPINE

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“…Ukegawa et al . 17 have shown that biphasic stimulation with a constant-current stimulator is an effective TES-MEP monitoring method and may reduce measurement time. However, they only compared monophasic and biphasic stimulation with a constant-current stimulator and did not report on the effects of constant-voltage stimulators or monophasic stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…We therefore conclude that when using constant-current stimulators, it is necessary to switch the stimulation polarity to study muscle responses bilaterally in order to avoid the disadvantages of monophasic stimulation. Alternatively, it may be necessary to use biphasic stimulation 17 . We believe that this information is important for surgeons to maintain adequate intraoperative spinal cord monitoring to prevent spinal cord injury during surgery.…”

Section: Discussionmentioning

confidence: 99%

Monophasic transcranial constant-current versus constant-voltage stimulation of motor-evoked potentials during spinal surgery

Masuda

Shigematsu

Tanaka

et al. 2019

Sci Rep

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Constant-voltage and constant-current stimulators may be used for transcranial electrical stimulation of motor evoked potentials (TES-MEP). However, no previous report has determined whether the two monophasic stimulation methods lead to similar responses during intra-operative monitoring. We studied differences in the lateralities of compound muscle action potentials (CMAPs) during intra-operative spinal cord monitoring via TES-MEP using monophasic constant-current and constant-voltage stimulations. CMAPs were bilaterally recorded from the upper and lower limb muscles in 95 patients who underwent elective spine and spinal cord surgery. We used two monophasic stimulation patterns: pattern 1, right anode and left cathode; pattern 2, right cathode and left anode. There were no statistically significant differences between the right and left sides with respect to success rates, wave amplitudes, and efficiencies, with constant-voltage stimulation, however, there were statistically significant differences between the right and left sides with constant-current stimulation. In case of our stimulation condition, there were no statistically significant differences between the right and left sides with respect to CMAPs with constant-voltage stimulation; constant-current stimulation was influenced by the type of monophasic stimulation, which necessitates the switch the polarity of the stimulation to bilaterally record CMAPs.

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“…The major clinical characteristics and diagnosis of the population were showed in Table 1. Patients were eligible for this study when they met all the following inclusion criteria: (1) presenting with symptomatic CCM with at least 1 clinical sign of myelopathy; (2) evidence of objective CCM on a magnetic resonance image (MRI); (3) absence symptomatic lumbar stenosis or thoracic myelopathy; (4) no previous surgical treatment for CCM; (5) undergoing the same anesthesia regime. Patients' duration of symptoms and preop modified Japanese Orthopedic Association (mJOA) scores associated with MEP phenotypes were showed in Fig.…”

Section: Patientsmentioning

confidence: 99%

“…It is important to assess cervical cord function in patients with CCM during surgical treatment. Over the past decades, the majority of studies are concerning the application of intraoperative transcranial motor evoked potential (MEP) to detect impending spinal cord damage, early warning the operating team to take action to avoid injury in cervical spine surgery [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients

et al. 2020

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Background: Surgery is usually the treatment of choice for patients with cervical compressive myelopathy (CCM). Motor evoked potential (MEP) has proved to be helpful tool in evaluating intraoperative cervical spinal cord function change of those patients. This study aims to describe and evaluate different MEP baseline phenotypes for predicting MEP changes during CCM surgery. Methods: A total of 105 consecutive CCM patients underwent posterior cervical spine decompression were prospectively collected between December 2012 and November 2016. All intraoperative MEP baselines recorded before spinal cord decompression were classified into 5 types (I to V) that were carefully designed according to the different MEP parameters. The postoperative neurologic status of each patient was assessed immediately after surgery. Results: The mean intraoperative MEP changes range were 10.2% ± 5.8, 14.7% ± 9.2, 54.8% ± 31.9, 74.1% ± 24.3, and 110% ± 40 in Type I, II, III, IV, and V, respectively. There was a significant correlation of the intraoperative MEP change rate with different MEP baseline phenotypes (r = 0.84, P < 0.01). Postoperative transient new spinal deficits were found 0/31 case in Type I, 0/21 in Type II, 1/14 in Type III, 2/24 in Type IV, and 4/15 in Type V. No permanent neurological injury was found in our cases series. Conclusions: The MEP baselines categories for predicting intraoperative cervical cord function change is proposed through this work. The more serious the MEP baseline abnormality, the higher the probability of intraoperative MEP changes, which is beneficial to early warning for the cervical cord injury.

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Efficacy of Biphasic Transcranial Electric Stimulation in Intraoperative Motor Evoked Potential Monitoring for Cervical Compression Myelopathy

Abstract: 4.

Cited by 14 publications

References 19 publications

Exploration of the Intraoperative Motor Evoked Potential

Exploration of the Intraoperative Motor Evoked Potential

Monophasic transcranial constant-current versus constant-voltage stimulation of motor-evoked potentials during spinal surgery

The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients

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