Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients

Abstract

A prospective study was performed on 217 patients who received MIOM during corrective surgery of spinal deformities between March 2000 and December 2005. Aim is to determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during corrective spine surgery. MIOM is becoming an increasingly used method of monitoring function during corrective spine surgery. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information regarding any neurological deficits during the operation. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 217 consecutive patients with spinal deformities of different aetiologies were monitored by means of MIOM during the surgical procedure. Out of which 201 patients presented true negative findings while one patient presented false negative and three patients presented false positive findings. Twelve patients presented true positive findings where neurological deficit after the operation was predicted. All neurological deficits in those 12 patients recovered completely. The sensitivity of MIOM applied during surgery of spinal deformities has been calculated of 92.3% and the specificity 98.5%. Based upon the results of this study MIOM is an effective method of monitoring the spinal cord and nerve root function during corrective surgery of spinal deformities and consequently improves postoperative results. The Wake-up test for surgical procedure of spinal deformities became obsolete in our institution.

Usefulness of multi-channels in intraoperative spinal cord monitoring: multi-center study by the monitoring committee of the Japanese Society for Spine Surgery and related research

“…Eggspuehler et al [28] employed CMAP in 216 cases of spinal deformity, reporting the average number of channels to be 2.8 pairs (5.6 channels). Eggspuehler et al [29] also employed CMAP in 241 cases of cervical spine surgery, reporting the average number of channels to be 2.6 pairs (5.2 channels).…”

Improving safety in spinal deformity surgery: advances in navigation and neurologic monitoring

“…For these reasons and others, there is always been great interest in real time, accurate monitoring of the spinal cord and nerve roots. Recording cerebral evoked potentials through the human scalp was first described by Dawson in 1947 [31] and increasing interest arouse since then for studying established spinal cord injuries [32]. Somatosensory evoked potentials (SEP) was introduced in the 1970's for functional neurophysiological assessment during spine and spinal cord surgery have improved rapidly [32,33].…”

A survey of the “surgical and research” articles in the European Spine Journal, 2007

“…We are introduced to the concept of multimodal intraoperative monitoring, and that it consists of intraoperative spinal and cortical-evoked potentials combined with continuous EMG and motor evoked potentials of muscles [50]. We are provided with an American view, by a neurologist, anesthesiologist and spine surgeon [36], and then a number of papers dealing with its use and results in various types of spinal surgery, principally from the Schulthess Clinic Zurich, Switzerland [14][15][16]51], from Italy [43] and Saudi Arabia [33]. These papers cover the use of MIOM in the thoracolumbar spine, the thoracic spine, the cervical spine, dealing with stenosis and deformity, and also intramedullary tumors [43,51].…”