Intraoperative Multimodality Monitoring in Adult Spinal Deformity

Quraishi, Nasir A.; Lewis, Stephen J.; Kelleher, Michael O.; Sarjeant, Roger; Rampersaud, Y. Raja; Fehlings, Michael G.

doi:10.1097/brs.0b013e3181a87b66

Cited by 111 publications

(14 citation statements)

References 27 publications

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“…[58–9] Currently, one such widely used technique is SSEP. [19] Although SSEP monitoring has been utilized with great success in scoliosis and thoracolumbar spine surgery,[10121317303139–42464953–55] where it has been credited with reducing the incidence of neurological complications from 4–6.9% to 0–0.7%,[21226355254] the usefulness of such a procedure in anterior cervical spine surgery (particularly in patients without myelopathy) is still unclear. [18323337] Indeed, although some studies have attributed SSEP monitoring to decrease the incidence of postoperative neurologic injury from 3.7 to 0%,[13] others have found SSEP monitoring in cervical spine surgery to be less useful, with Jones et al .…”

Section: Discussionmentioning

confidence: 99%

A role for motor and somatosensory evoked potentials during anterior cervical discectomy and fusion for patients without myelopathy: Analysis of 57 consecutive cases

Xu¹,

Ritzl²,

Sait³

et al. 2011

Surg Neurol Int

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Background:Although the usage of combined motor and sensory intraoperative monitoring has been shown to improve the surgical outcome of patients with cervical myelopathy, the role of transcranial electric motor evoked potentials (tceMEP) used in conjunction with somatosensory evoked potentials (SSEP) in patients presenting with radiculopathy but without myelopathy has been less clear.Methods:We retrospectively reviewed all patients (n = 57) with radiculopathy but without myelopathy, undergoing anterior cervical decompression and fusion at a single institution over the past 3 years, who had intraoperative monitoring with both tceMEPs and SSEPs.Results:Fifty-seven (100%) patients presented with radiculopathy, 53 (93.0%) with mechanical neck pain, 35 (61.4%) with motor dysfunction, and 29 (50.9%) with sensory deficits. Intraoperatively, 3 (5.3%) patients experienced decreases in SSEP signal amplitudes and 4 (6.9%) had tceMEP signal changes. There were three instances where a change in neuromonitoring signal required intraoperative alteration of the surgical procedure: these were deemed clinically significant events/true positives. SSEP monitoring showed two false positives and two false negatives, whereas tceMEP monitoring only had one false positive and no false negatives. Thus, tceMEP monitoring exhibited higher sensitivity (33.3% vs. 100%), specificity (95.6% vs. 98.1%), positive predictive value (33.3% vs. 75.0%), negative predictive value (97.7% vs. 100%), and efficiency (91.7% vs. 98.2%) compared to SSEP monitoring alone.Conclusions:Here, we present a retrospective series of 57 patients where tceMEP/SSEP monitoring likely prevented irreversible neurologic damage. Though further prospective studies are needed, there may be a role for combined tceMEP/SSEP monitoring for patients undergoing anterior cervical decompression without myelopathy.

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Section: Discussionmentioning

confidence: 99%

A role for motor and somatosensory evoked potentials during anterior cervical discectomy and fusion for patients without myelopathy: Analysis of 57 consecutive cases

Xu¹,

Ritzl²,

Sait³

et al. 2011

Surg Neurol Int

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“…[24] Intraoperatively, successful recordings included; SEP s in 101 (99%), EMG s in 89 (87%), and MEP s in 12 of 16 (75%) cases. The overall combined sensitivity was 100%.…”

Section: Intraoperative Monitoring In Cervical Surgerymentioning

confidence: 99%

The need to add motor evoked potential monitoring to somatosensory and electromyographic monitoring in cervical spine surgery

Epstein

2013

Surg Neurol Int

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Intraoperative neural monitoring (IONM), utilizing somatosensory evoked potentials (SEP) and electromyography (EMG), was introduced to cervical spine surgery in the late 1980's. However, as SEP only provided physiological data regarding the posterior cord, new motor deficits were observed utilizing SEP alone. This prompted the development of motor evoked potential monitoring (MEP) which facilitated real-time assessment of the anterior/anterolateral spinal cord. Although all three modalities, SEP, EMG, and MEP, are routinely available for IONM of cervical spine procedures, MEP are not yet routinely employed. The purpose of this review is to emphasize that MEP should now routinely accompany SEP and EMG when performing IONM of cervical spine surgery. Interestingly, one of the most common reasons for malpractice suits involving the cervical spine, is quadriparesis/quadriplegia following a single level anterior cervical diskectomy and fusion (ACDF). Previously, typical allegations in these suits included; negligent surgery, lack of informed consent, failure to diagnose/treat, and failure to brace. Added to this list, perhaps, as the 5th most reason for a suit will be failure to monitor with MEP. This review documents the value of MEP monitoring in addition to SEP and EMG monitoring in cervical spine surgery. The addition of MEP0 should minimize major motor injuries, and more accurately and reliably detect impending anterior cord deterioration that may be missed with SEP monitoring alone.

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“…[39] Similarly, combined neurophysiological monitoring with electromyography and SSEP recording, and the selective use of motor evoked potential was found to be helpful for predicting and possibly preventing neurological injury during cervical spine surgery. [40]…”

Section: Neuro-monitoringmentioning

confidence: 99%

Research studies that have influenced practice of neuroanesthesiology in recent years: A literature review

Gupta¹,

Pandia²,

Dash³

2013

Indian J Anaesth

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Through evolving research, recent years have witnessed remarkable achievements in neuromonitoring and neuroanesthetic techniques, with a huge body of literature consisting of excellent studies in neuroanaesthesiology. However, little of this work appears to be directly important to clinical practice. Many controversies still exist in care of patients with neurologic injury. This review discusses studies of great clinical importance carried out in the last five years, which have the potential of influencing our current clinical practice and also attempts to define areas in need of further research. Relevant literature was obtained through multiple sources that included professional websites, medical journals and textbooks using key words “neuroanaesthesiology,” “traumatic brain injury,” “aneurysmal subarachnoid haemorrhage,” “carotid artery disease,” “brain protection,” “glycemic management” and “neurocritical care.” In head injured patients, administration of colloid and pre-hospital hypertonic saline resuscitation have not been found beneficial while use of multimodality monitoring, individualized optimal cerebral perfusion pressure therapy, tranexamic acid and decompressive craniectomy needs further evaluation. Studies are underway for establishing cerebroprotective potential of therapeutic hypothermia. Local anaesthesia provides better neurocognitive outcome in patients undergoing carotid endarterectomy compared with general anaesthesia. In patients with aneurysmal subarachnoid haemorrhage, induced hypertension alone is currently recommended for treating suspected cerebral vasospasm in place of triple H therapy. Till date, nimodipine is the only drug with proven efficacy in preventing cerebral vasospasm. In neurocritically ill patients, intensive insulin therapy results in substantial increase in hypoglycemic episodes and mortality rate, with current emphasis on minimizing glucose variability. Results of ongoing multicentric trials are likely to further improvise our practice.

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Intraoperative Multimodality Monitoring in Adult Spinal Deformity

Cited by 111 publications

References 27 publications

A role for motor and somatosensory evoked potentials during anterior cervical discectomy and fusion for patients without myelopathy: Analysis of 57 consecutive cases

A role for motor and somatosensory evoked potentials during anterior cervical discectomy and fusion for patients without myelopathy: Analysis of 57 consecutive cases

The need to add motor evoked potential monitoring to somatosensory and electromyographic monitoring in cervical spine surgery

Research studies that have influenced practice of neuroanesthesiology in recent years: A literature review

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