Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: A review focus on the corticospinal tracts

Deletis, Vedran; Sala, Francesco

doi:10.1016/j.clinph.2007.09.135

Cited by 358 publications

(253 citation statements)

References 104 publications

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“…Nowadays, the combined recording of SEPs and MEPs has become a wellestablished method for intraoperative testing of spinal cord function in complex spine and/or spinal cord surgery (see ref. [7] for a comprehensive review). Although there is general agreement as to the methodology to elicit both e-MEPs and m-MEPs, controversies do persist as to the indications for IOM with both e-MEPs and m-MEPs [6,[10][11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…The introduction of transcranially motor evoked potentials (MEPs) represented a significant step forward for intraoperative assessment of motor pathway function in spine surgery [1][2][3][4][5][6][7]. Two methodologies have been developed to elicit MEPs by transcranial electrical stimulation [7]:…”

Section: Introductionmentioning

confidence: 99%

“…Whilst m-MEPs depend also by the excitability of facilitatory cortical motor neurons, beyond the spinal cord conductivity and the excitability of lower motoneurons [7,9].…”

Section: Introductionmentioning

confidence: 99%

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Relevance of intraoperative D wave in spine and spinal cord surgeries

2012

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Purpose The combined recordings of epidural-(D wave) and muscle motor evoked potentials (m-MEPs) have been proposed in many studies in intramedullary spinal cord tumour (IMSCT) surgery, although not all agree. Furthermore, the usefulness of the intraoperative monitoring of motor systems using these methods in other types of spine surgery has not yet been clearly confirmed. The aim of this study is to test the impact of intraoperative D wave on the monitorability and motor outcome in spine surgery. Methods Intraoperative recording of posterior tibial nerve somatosensory potentials, lower limb m-MEPs (LLmMEPs) and epidurally recorded D wave caudally to the surgical level was attempted in a total of 103 spine and spinal cord surgeries (23 IMSCT, 55 extramedullary spinal cord tumours and 25 myelopathies). Results There was a 97.1 %, overall monitorability where at least 1 of the 3 modalities was applicable in 100 surgical procedures. Baseline LLm-MEPs were recorded bilaterally in 85 cases and unilaterally in 11. A caudal D wave was recorded in 97 cases. Transient, or persistent intraoperative modifications occurred in 14/23 IMSCT, 5/55 extramedullary spinal cord tumours and in 2/25 myelopathies. The presence of a persistent stable caudal D wave was predictive of a good motor outcome even when the LL-MEPs were absent and/or when lost during surgery.Conclusions Not only is intraoperative D wave recording to be considered mandatory in IMSCT surgery but it should also be attempted in other types of spine/spinal cord surgeries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relevance of intraoperative D wave in spine and spinal cord surgeries

2012

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“…Thus a changing amplitude has enhanced significance. D waves are more commonly used during intramedullary spinal cord surgery where recording electrodes are placed by the surgeon in the field [ 11,34,35 ] .…”

Section: Technical Aspects Of Mep Monitoringmentioning

confidence: 99%

Transcranial Motor-Evoked Potentials

Jameson¹

2017

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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“…[8][9][10] On the other hand, the last years have been testimony to the development of well-established techniques to intraoperatively assess spinal cord function during spine and spinal cord surgeries. [11][12][13] Particularly, the combined recordings of muscle MEPs (m-MEPs) and the epidurally recorded D wave provide relevant prognostic information on motor outcome. 11,14 Neurophysiologic techniques can be therefore applied intraoperatively with the aim to define the neurophysiologic profile of the acutely SCI patient, to identify biological marker of functionally complete spinal cord lesion and to assess chances for recovery, particularly motor outcome.…”

Section: Introductionmentioning

confidence: 99%

Neurophysiological assessment of the injured spinal cord: an intraoperative approach

et al. 2014

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Study design: Prospective, observational study. Objectives: To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials (e-SEPs) and predicting the outcome of spinal cord injury (SCI). Setting: Regional Trauma Center, Torino, Italy. Methods: Fifty-five patients were intraoperatively studied during posterior spine stabilization surgery for traumatic SCI. In all, 21 of these had complete SCI, 14 an incomplete SCI-6 of them with central cord syndrome and 1 with central cord plus Brown Sequard syndrome-and 20 patients were neurologically uncompromised. Results: The neurophysiologic profile of the complete SCI was the absence of both m-MEPs and e-MEPs caudally to the lesion site, associated with a lack of cortical and e-SEPs cranially to the lesion site. None of these patients recovered motor function in the follow-up. A clearly detectable caudal D wave was associated with motor recovery even in deeply paraparetic patients. In one neurologically incomplete patient a reversible deterioration of m-MEPs and e-MEPs was observed during the compression-distraction manoeuvre. Conclusion: Intraoperative neurophysiological evaluation of SCI patients can provide information about spinal cord function that is not retrievable by other clinical means and can correctly predict neurological outcome. Intraoperative testing during early stabilization of the spine of deeply paraparetic SCI patients provides additional information about their neurological profile.

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Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: A review focus on the corticospinal tracts

Cited by 358 publications

References 104 publications

Relevance of intraoperative D wave in spine and spinal cord surgeries

Relevance of intraoperative D wave in spine and spinal cord surgeries

Transcranial Motor-Evoked Potentials

Neurophysiological assessment of the injured spinal cord: an intraoperative approach

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