Multimodal intraoperative monitoring (MIOM) during surgical decompression of thoracic spinal stenosis in 36 patients

Abstract

A prospective study of 36 patients who received multimodal intraoperative monitoring (MIOM) during decompression of thoracic spinal stenosis between March 2000 and December 2005 was chosen as the study design. The objective was to determine the sensitivity and specificity of MIOM techniques used for monitoring spinal cord during surgical thoracic decompression. The background data revealed that the surgical decompression for thoracic spinal stenosis is less frequent than in other regions of the spine. However, due to the relative narrow spinal canal, neurological complications could be severe. The combination of monitoring ascending and descending pathways may provide an early alert to the surgeon in order to alter the surgical procedure, and avoid neurological complications. The methods involved evaluation of intraoperative somatosensory spinal and cerebral evoked potentials and motor evoked potentials of the spinal cord and muscles that were compared with post operative clinical neurological changes. 36 consecutive patients with thoracic spinal stenosis of different aetiologies were monitored by the means of MIOM during the surgical procedure. 31 patients had true negative while one patient had false positive findings. Three patients had true positive and one patient had false negative findings. This indicates a sensitivity of 75% and a specificity of 97%. The one case of false negative findings recovered completely within 3 months. In conclusion, the MIOM is an effective method of monitoring the spinal cord during surgical decompression of the thoracic spine.

Current opinions and recommendations on multimodal intraoperative monitoring during spine surgeries

“…The high sensitivity and specificity of MIOM during the different surgical procedures as presented in this supplement [10][11][12][28][29][30][31] document its advantages. It has been clearly shown that MEP monitoring improves outcome after surgery for intramedullary spinal tumors [27].…”

Progress in Intraoperative Neurophysiological Monitoring for the Surgical Treatment of Thoracic Spinal Stenosis

“…Theoretically, MIOM not only minimizes the incidence of false-negative events, but also provides acquisition of preoperative monitoring signal. 24 SEPs and MEPs complement each other in the monitoring process and accurately respond to the functional state of spinal cord in a timely manner. MIOM has been widely used in clinical practice due to its great advantages.…”

Treatment strategies for the surgical complications of thoracic spinal stenosis: a retrospective analysis of two hundred and eighty three cases

“…We stopped using this technique because of the high risk of intraoperative complications and poor results and now use the encroachment method to perform laminectomy in patients with OLF [11]. Use of the Kerrison rongeur often results in spinal cord injury due to irritation of the spinal cord and its blood supply [12,13]. Intraoperative spinal cord injury occurred in two patients in our series who underwent surgery by the original method for these reasons.…”