Multimodal intraoperative monitoring (MIOM) during cervical spine surgical procedures in 246 patients

Abstract

A prospective study of 246 patients who received multimodal intraoperative monitoring during cervical spine surgery between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during cervical spine surgery. It is appreciated that complication rate of cervical spine surgery is low, however, there is a significant risk of neurological injury. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information and/or alert regarding any neurological changes during the operation to the surgeon. 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 246 consecutive patients with cervical pathologies, majority spinal stenosis due to degenerative changes of cervical spine were monitored by means of MIOM during the surgical procedure. About 232 patients presented true negative while 2 patients false negative responses. About ten patients presented true positive responses where neurological deficit after the operation was predicted and two patients presented false positive findings. The sensitivity of MIOM applied during cervical spine procedure (anterior and/or posterior) was 83.3% and specificity of 99.2%. MIOM is an effective method of monitoring the spinal cord functional integrity during cervical spine surgery and can help to reduce the risk of neurological deficit by alerting the surgeon when monitoring changes are observed.

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). Multimodal intraoperative monitoring (MIOM) was performed in the cases in all of the reports to employ other monitoring methods to detect paralysis.…”

Transcranial Motor-Evoked Potentials

“…Obtained from the author's archive However the evidence does not meet the level 1 standard (large randomized, placebo controlled, double blind studies). The evidence is based on large case series and meta analysis (level 2, 3 evidence) where MEP changes predicted immediate postsurgical neurological findings [ 10,[42][43][44] .…”

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

“…The advent of corticospinal motor pathway monitoring through the use of motor evoked potentials (MEPs) elicited by transcranial electrical stimulation added more information for the surgeon. Such achievements during the last 15 years turned neuromonitoring into the standard of care to assess proper hardware position in the spine [34][35][36][37][38][39][40] and also making more aggressive corrections in spinal deformities possible [41][42][43][44][45][46]. Different protocols might combine evoked potentials (SEPs and MEPs) [33,[47][48][49][50][51], transcranial electric motor evoked potentials (tcMEP) [52] and triggered or free-running electromyography [35,36,53,54] and it is crucial to understand their differences to prompt proper communication between surgeons, anesthetists and the neuromonitoring team.…”