Electrophysiologic deterioration in surgery for thoracic disc herniation: impact of mean arterial pressures on surgical outcome

Zuckerman, Scott L.; Forbes, Jonathan A.; Mistry, Akshitkumar M.; Krishnamoorthi, Harish; Weaver, Sheena M.; Mathews, Letha; Cheng, Joseph; McGirt, Matthew J.

doi:10.1007/s00586-014-3390-z

Cited by 16 publications

(6 citation statements)

References 21 publications

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“…The association between pre‐operative neurological deficit and neurophysiological monitoring has been illustrated in previous studies 4,9,12,13 . Chen et al 9 .…”

Section: Discussionmentioning

confidence: 70%

Intra‐operative Neurophysiological Monitoring in Patients Undergoing Posterior Spinal Correction Surgery with Pre‐operative Neurological Deficit: Its Feasibility and High‐risk Factors for Failed Monitoring

Liu,

Li,

Qiu

et al. 2023

Orthopaedic Surgery

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ObjectiveConsidering spinal deformity patients with pre‐operative neurological deficit were associated with more intra‐operative iatrogenic neurological complications than those without, intra‐operative neurophysiological monitoring (IONM) has been used for detecting possible iatrogenic injury timely. However, the IONM waveforms are often unreliable. To analyze the performance of intra‐operative neurophysiological monitoring (IONM) including somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) in patients with pre‐operative neurological deficit undergoing posterior spinal correction surgery, and to identify the high‐risk factors for failed IONM.MethodsPatients with pre‐operative neurological deficit undergoing posterior spinal correction surgery between October 2017 and January 2022 were retrospectively reviewed. The presence or absence of SEP and MEP of target muscles were separately recorded. The P37/N50 latency and amplitude of SEP, and the MEP amplitude were measured. Any IONM alerts were also recorded. The IONM performance was compared among patients with different etiologies, levels responsible for neurological deficit, and strength of IONM‐target muscles. Patients' demographics were analyzed using the descriptive statistics and were presented with mean ± standard deviation. Comparison analysis was performed using χ2‐test and statistically significant difference was defined as p < 0.05.ResultsA total of 270 patients (147 males, 123 females) with an average age of 48.4 ± 36.7 years were involved. The SEP records were available in 371 (68.7%) lower extremities while MEP records were available in 418 (77.4%). SEP alerts were reported in 31 lower extremities and MEP alerts in 22, and new neurological deficit at post‐operation was observed in 11. The etiologies of neuromuscular and syndromic indicated relatively lower success rates of IONM, which were 44.1% and 40.5% for SEP, and 58.8% and 59.5% for MEP (p < 0.001). In addition, patients with pre‐operative neurological deficit caused by cervical spine and muscle strength lower than grade 4 suffered from higher risk of failed IONM waveforms (p < 0.001).ConclusionPatients with pre‐operative neurological deficit suffered from a higher incidence of failed IONM results. The high‐risk for failed IONM waveforms included the neuromuscular and syndromic etiologies, neurological deficit caused by cervical spine, muscle strength lower than grade 4 in patients with pre‐operative neurological deficit undergoing posterior spinal correction surgery.

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“…The association between pre‐operative neurological deficit and neurophysiological monitoring has been illustrated in previous studies 4,9,12,13 . Chen et al 9 .…”

Section: Discussionmentioning

confidence: 70%

Intra‐operative Neurophysiological Monitoring in Patients Undergoing Posterior Spinal Correction Surgery with Pre‐operative Neurological Deficit: Its Feasibility and High‐risk Factors for Failed Monitoring

Liu,

Li,

Qiu

et al. 2023

Orthopaedic Surgery

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show abstract

“…The association between pre-operative neurological deficit and neurophysiological monitoring has been illustrated in previous studies [4,7,9,10]. Chen et al [7] reviewed the IONM data in 341 consecutive "high-risk" neurosurgical or orthopedic procedures, showing that the success rate was only 39.1% for lower extremities in patients with preoperative motor deficit and up to 81% in neurologically intact adults.…”

Section: Discussionmentioning

confidence: 94%

Intra-operative neurophysiological monitoring in patients with pre-operative neurological deficit: its feasibility and high-risk factors for failed monitoring

Qiu

Liu

et al. 2023

Preprint

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Objective. To analyze the performance of intra-operative neurophysiological monitoring (IONM) including somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) in patients with pre-operative neurological deficit and to identify the high-risk factors for failed IONM. Methods. Patients with pre-operative neurological deficit undergoing spinal surgery between October 2010 and August 2019 were retrospectively reviewed. The presence or absence of SEP and MEP of target muscles were separately recorded and the high-risk factors for failed IONM results were investigated. Results. A total of 136 patients (86 males, 50 females) with an average age of 43.0±17.7 years were included. The muscle strength of recorded muscles in 272 lower extremities included grade 1 in 25 muscles, grade 2 in 15, grade 3 in 41, grade 4 in 134 and grade 5 in 57. The SEP records were available in 177 (65.1%) lower extremities while MEP records were available in 199 (73.2%) lower extremities. Significantly higher success rates of SEP and MEP were obtained in lower extremities with muscle strength of grade 4-5 than those of grade 1-3 (P<0.001). Patients with spinal trauma and cervical spinal stenosis were associated with more prevalent failed IONM results. Conclusions. The overall success rates of SEP and MEP were 65.1% and 73.2%, respectively. The high-risk indicators for failed IONM results included muscle strength lower than grade 4, spinal trauma and cervical spinal stenosis.

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“…Only a few studies have investigated the effects of blood pressure on mTc-MEP, most of which were performed in animal experimental models [12,14,15,26,27,[40][41][42]. Two studies showed that hypotension is associated with decreased mTc-MEP amplitude and increased voltage threshold [15,43].…”

Section: Discussionmentioning

confidence: 99%

The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol

Dulfer

Sahinovic

Lange

et al. 2021

J Clin Monit Comput

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For high-risk spinal surgeries, intraoperative neurophysiological monitoring (IONM) is used to detect and prevent intraoperative neurological injury. The motor tracts are monitored by recording and analyzing muscle transcranial electrical stimulation motor evoked potentials (mTc-MEPs). A mTc-MEP amplitude decrease of 50–80% is the most common warning criterion for possible neurological injury. However, these warning criteria often result in false positive warnings. False positives may be caused by inadequate depth of anesthesia and blood pressure on mTc-MEP amplitudes. The aim of this paper is to validate the study protocol in which the goal is to investigate the effects of depth of anesthesia (part 1) and blood pressure (part 2) on mTc-MEPs. Per part, 25 patients will be included. In order to investigate the effects of depth of anesthesia, a processed electroencephalogram (pEEG) monitor will be used. At pEEG values of 30, 40 and 50, mTc-MEP measurements will be performed. To examine the effect of blood pressure on mTc-MEPs the mean arterial pressure will be elevated from 60 to 100 mmHg during which mTc-MEP measurements will be performed. We hypothesize that by understanding the effects of depth of anesthesia and blood pressure on mTc-MEPs, the mTc-MEP monitoring can be interpreted more reliably. This may contribute to fewer false positive warnings. By performing this study after induction and prior to incision, this protocol provides a unique opportunity to study the effects of depths of anesthesia and blood pressure on mTc-MEPs alone with as little confounders as possible.Trial registration number NL7772.

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Electrophysiologic deterioration in surgery for thoracic disc herniation: impact of mean arterial pressures on surgical outcome

Cited by 16 publications

References 21 publications

Intra‐operative Neurophysiological Monitoring in Patients Undergoing Posterior Spinal Correction Surgery with Pre‐operative Neurological Deficit: Its Feasibility and High‐risk Factors for Failed Monitoring

Intra‐operative Neurophysiological Monitoring in Patients Undergoing Posterior Spinal Correction Surgery with Pre‐operative Neurological Deficit: Its Feasibility and High‐risk Factors for Failed Monitoring

Intra-operative neurophysiological monitoring in patients with pre-operative neurological deficit: its feasibility and high-risk factors for failed monitoring

The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol

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