Multi-channel motor evoked potential monitoring during anterior cervical discectomy and fusion

Kim, Dong‐Gun; Jo, Seong-Rae; Park, Young-Seop; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib; Park, Kyung Seok

doi:10.1016/j.cnp.2016.12.006

Cited by 16 publications

(5 citation statements)

References 21 publications

(24 reference statements)

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“…3,22,30 By contrast, MEP monitoring has been shown to be highly sensitive and specific in identifying impending C5 deficit. 3,7,31,32 C5-6 nerve root alerts were equally common across the diagnostic cohorts in the present study, and importantly, the probability of resolving those alerts and avoiding dysfunction was comparable.…”

Section: Discussionsupporting

confidence: 50%

Linking Patterns of Intraoperative Neuromonitoring (IONM) Alerts to the Odds of a New Postoperative Neurological Deficit

Wilent

Tesdahl²,

Epplin-Zapf³

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Objective: Characterize intraoperative neuromonitoring alerts by the patterns of modalities and nerves/muscles involved and quantify risk of new-onset neurological deficit for patients with a primary diagnosis of myelopathy, stenosis, or radiculopathy.Summary of Background Data: Phenotyping alert patterns and linking those patterns with risk is needed to facilitate clinical decision-making.Methods: Cases with alerts were categorized by patterns of modalities or nerves/muscles involved, and alert status at closure. Unadjusted odds ratios (ORs) for new-onset neurological deficit were calculated. A mixed-effects logistic regression model controlling for demographic and operative factors, with random intercepts to account for clustering in outcomes by surgeon and surgical neurophysiologist was also used to calculate ORs and probabilities of neurological deficit.Results: There was significantly increased risk of a new neurological deficit for procedures involving posterior compared with anterior approaches (OR: 1.82, P = 0.001) and procedures involving three levels compared with one (OR: 2.17, P = 0.001). Odds of a deficit were lower for patients with radiculopathy compared with myelopathy (OR: 0.69, P = 0.058). Compared with cases with no alerts, those with unresolved Spinal Cord alerts were associated with the greatest elevation in risk (OR: 289.05) followed by unresolved C5-6 Nerve Root (OR: 172.7), C5-T1 Nerve Root/Arm (OR: 162.89), C7 Nerve Root (OR:84.2), and C8-T1 Nerve Root alerts (OR:75.49, all P < 0.001). Significant reductions in risk were seen for resolved Spinal Cord, C5-6 Nerve Root, and C8-T1 nerve alerts. Overall, unresolved motor evoked potential and somatosensory evoked potential alerts were associated with the greatest elevation in risk (OR:340.92) followed by unresolved motor evoked potentialonly (OR:140.6) and unresolved somatosensory evoked potential-Only alerts (OR:78.3, all P < 0.001). These relationships were similar across diagnostic cohorts.Conclusions: Risk elevation and risk mitigation after an intraoperative neuromonitoring alert during surgery is dependent on the type and pattern of alert.

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Section: Discussionsupporting

confidence: 50%

Linking Patterns of Intraoperative Neuromonitoring (IONM) Alerts to the Odds of a New Postoperative Neurological Deficit

Wilent

Tesdahl²,

Epplin-Zapf³

et al. 2023

Clinical Spine Surgery: A Spine Publication

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“…Their reported sensitivity and specificity were 100% for tcMEP; however, since SSEP changes were present in only 1 of the 2 patients with a deficit, the authors concluded only 25% sensitivity but 100% specificity. Similarly, Kim et al, 37 in a retrospective review of 200 consecutive patients, reported the usefulness of multi-channel tcMEPs in the detection of spinal cord injury during anterior cervical surgery. Additionally, Fujiwara et al 38 showed the effectiveness of tcMEP in identifying acute-type postoperative C5 palsy following cervical laminoplasty; however, the rate of delayed palsy was unpredictable.…”

Section: The Use Of Ionm During Cervical Spine Surgerymentioning

confidence: 92%

The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery

Charalampidis

Jiang

Wilson

et al. 2020

Global Spine Journal

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Study Design: Narrative review. Objective: To summarize relevant studies regarding the utilization of intraoperative neurophysiological monitoring (IONM) techniques in spine surgery implemented in recent years. Methods: A literature search of the Medline database was performed. Relevant studies from all evidence levels have been included. Titles, abstracts, and reference lists of key articles were included. Results: Multimodal intraoperative neurophysiological monitoring (MIONM) has the advantage of compensating for the limitations of each individual technique and seems to be effective and accurate for detecting perioperative neurological injury during spine surgery. Conclusion: Although there are no prospective studies validating the efficacy of IONM, there is a growing body of evidence supporting its use during spinal surgery. However, the lack of validated protocols to manage intraoperative alerts highlights a critical knowledge gap. Future investigation should focus on developing treatment methodology, validating practice protocols, and synthesizing clinical guidelines.

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“…The cause for this difference is unclear. Multichannel use of both tcMEPs and EMG monitoring in our study may be a possible reason ( Kim et al, 2017 ). One strength of our study is that almost all included IONM patients had complete information from multimodal monitoring (combination of SSEP, tcMEP, and EMG), and all monitoring was performed in anesthesia using TIVA that minimizes the effects on monitoring.…”

Section: Discussionmentioning

confidence: 95%

Neurophysiological monitoring during anterior cervical discectomy and fusion for ossification of the posterior longitudinal ligament

Kim

Yang

et al. 2021

Clinical Neurophysiology Practice

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Multi-channel motor evoked potential monitoring during anterior cervical discectomy and fusion

Abstract: HighlightsWe analyzed 200 patients undergoing ACDF with multi-channel MEP monitoring.Multi-channel MEP monitoring showed a higher diagnostic accuracy for long tract and segmental injury.Multi-channel MEP monitoring could be useful for single- and multi-level ACDF.

Cited by 16 publications

References 21 publications

Linking Patterns of Intraoperative Neuromonitoring (IONM) Alerts to the Odds of a New Postoperative Neurological Deficit

Linking Patterns of Intraoperative Neuromonitoring (IONM) Alerts to the Odds of a New Postoperative Neurological Deficit

The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery

Neurophysiological monitoring during anterior cervical discectomy and fusion for ossification of the posterior longitudinal ligament

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