Real-Time Continuous Intraoperative Electromyographic and Somatosensory Evoked Potential Recordings in Spinal Surgery: Correlation of Clinical and Electrophysiologic Findings in a Prospective, Consecutive Series of 213 Cases

Gunnarsson, Þorsteinn; Krassioukov, Andrei V.; Sarjeant, Roger; Fehlings, Michael G.

doi:10.1097/01.brs.0000115144.30607.e9

Cited by 179 publications

(76 citation statements)

References 25 publications

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“…Some papers in the literature have reported the sensitivity and specificity of intraoperative monitoring, but all of them are related to single procedures which explains the low values derived [5,6]. In this study, in applying the multimodal approach, the overall sensitivity was 89% and a specificity of 99%.…”

Section: Discussionmentioning

confidence: 60%

The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1,017 patients

et al. 2007

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A prospective study of 1,017 patients who received MIOM during spine surgery procedures between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve roots function during spine surgery. MIOM has become a widely used method of monitoring neural function during spine surgery. Several techniques only monitor either ascending or descending pathways and thus may not provide sensitive or specific results. MIOM aims to monitor both ascending and descending pathways therefore giving immediate feedback information regarding any neurological deficits during the operation. Intraoperative sensory spinal and cortical evoked potentials, combined with monitoring of EMG and motor evoked potentials recorded from the spinal cord and muscles elicited by electrical motor cortex, spinal cord, cauda equina and nerve root stimulation, was evaluated and compared with post-operative clinical neurological changes. One thousand and seventeen consecutive patients underwent a total of 4,731 h of MIOM to evaluate any neural deficits that may have occurred during spine surgery. Of these, 935 were true negative cases, 8 were false negative cases, 66 were true positive cases and 8 were false positive cases, resulting in a sensitivity of 89% and a specificity of 99%. Based on the results of this study, MIOM is an effective method of monitoring the spinal cord functional integrity during spine surgery and therefore can lead to reduction of neurological deficit and consequently improve postoperative results.

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Section: Discussionmentioning

confidence: 60%

The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1,017 patients

et al. 2007

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“…We can hardly find a result of SSEP change for postoperative sensory deficit in terms of either quantitative or objective description of sensory change in the previous study [24,25]. At this retrospective study, we give up to measure postoperative sensory change as all that we could retrieve was subjective expression of patients about sensory change and vague dermatomal distribution.…”

Section: Predictability Of Mep and Ssep For Postoperative Motor Deficitmentioning

confidence: 99%

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

Kang¹,

Gwak²,

Shin³

et al. 2016

J Spine

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Objectives: To evaluate the feasibility, sensitivity and specificity of IOM for IDEM and ED metastatic spinal tumours, and to assess usefulness of SSEP for patients in whom MEP was not measurable. Methods and materials:One hundred and one consecutive patients with IDEM and ED metastatic spinal tumours at the cord level (C1 to L1) received surgery under SSEP and/or MEP was included. Feasibility of IOM was defined to be negative in case of no measurable MEP or SSEP under general anaesthesia after confirmation of reversal of neuromuscular block. More than 50% change of MEP or SSEP amplitude and more than 10% delay of SSEP latency were evaluated as positive signs of IOM change.Results: MEP was measurable in 74 out of 101 trials, thus feasibility is 73%. Patient with normal motor power showed higher feasibility than those with motor power 3 or less. (93% vs. 39%) Among 74 patients with measurable MEP, 19 patients showed positive MEP change and 14 patients got worse of their motor power postoperatively.

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“…In this situation, SSEPs in combination with sEMG are the modalities of choice for optimal neurophysiological monitoring. In a 2004 study, Gunnarsson et al 13 analyzed the sensitivity and specificity of detecting new postoperative motor deficits using multimodality monitoring during thoracolumbar procedures. They reported that sEMG has a sensitivity of 100% with a specificity of 23.7%.…”

Section: Lumbosacral Spine Surgerymentioning

confidence: 99%

Intraoperative neurophysiological monitoring during spine surgery: a review

Gonzalez¹,

Jeyanandarajan²,

Hansen³

et al. 2009

FOC

217

114

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Spinal surgery involves a wide spectrum of procedures during which the spinal cord, nerve roots, and key blood vessels are frequently placed at risk for injury. Neuromonitoring provides an opportunity to assess the functional integrity of susceptible neural elements during surgery. The methodology of obtaining and interpreting data from various neuromonitoring modalities—such as somatosensory evoked potentials, motor evoked potentials, spontaneous electromyography, and triggered electromyography—is reviewed in this report. Also discussed are the major benefits and limitations of each modality, as well as the strength of each alone and in combination with other modalities, with regard to its sensitivity, specificity, and overall value as a diagnostic tool. Finally, key clinical recommendations for the interpretation and step-wise decision-making process for intervention are discussed. Multimodality neuromonitoring relies on the strengths of different types of neurophysiological modalities to maximize the diagnostic efficacy in regard to sensitivity and specificity in the detection of impending neural injury. Thorough knowledge of the benefits and limitations of each modality helps in optimizing the diagnostic value of intraoperative monitoring during spinal procedures. As many spinal surgeries continue to evolve along a pathway of minimal invasiveness, it is quite likely that the value of neuromonitoring will only continue to become more prominent.

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Real-Time Continuous Intraoperative Electromyographic and Somatosensory Evoked Potential Recordings in Spinal Surgery: Correlation of Clinical and Electrophysiologic Findings in a Prospective, Consecutive Series of 213 Cases

Cited by 179 publications

References 25 publications

The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1,017 patients

The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1,017 patients

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

Intraoperative neurophysiological monitoring during spine surgery: a review

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