Somatosensory evoked potential monitoring in anterior thoracic vertebrectomy

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Spine surgeons have used intraoperative cortical and subcortical somatosensory evoked potential (SSEP) monitoring to detect changes in spinal cord function when intraoperative procedures can be performed to prevent neurological deterioration. However, the reliability of SSEP monitoring as applied to anterior thoracic vertebral body resections has not been rigorously assessed.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> The authors retrospectively reviewed hospital charts and operating room records obtained between August 1993 and December 1998 and found that SSEP monitoring was used in 44 surgical procedures involving an anterior approach for thoracic vertebral body resections.</jats:p> <jats:p content-type="fine-print">There were no patients in whom SSEP changes did not return to baseline during the surgical procedure. Patients in four cases, despite their stable SSEP recordings throughout the procedure, were noted immediately postoperatively to have experienced significant neurological deterioration. The false-negative rate in SSEP monitoring was 9%. Sensitivity was determined to be 0%.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> It is important to recognize high false-negative rates and low sensitivity of SSEP monitoring when it is used to record spinal cord function during anterior approaches for thoracic vertebrectomies. The insensitivity of SSEPs for motor deterioration during anterior thoracic vertebrectomies is likely due to the limitation of SSEPs, which monitor only posterior column function whereas motor paths are conveyed in the anterior and anterolateral spinal cord. The authors believe that SSEPs can not be relied on to detect reversible spinal damage during anterior thoracic vertebrectomies.</jats:p>

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

“…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%.…”

Intraoperative Somatosensory Evoked Potential Monitoring During Cervical Spine Corpectomy Surgery

“…The routine use of intraoperative SSEP monitoring has led to a dramatic reduction in new postoperative neurologic deficits during scoliosis and anterior thoracic spine surgery. 1,2 However, the usefulness of SSEP monitoring for other surgical procedures of the spine, such as anterior cervical spine surgery, has been the subject of debate in the literature. [3][4][5][6] Patients with cervical myelopathy often require anterior fusion and decompression with single-level or multilevel corpectomies.…”

Two cases of quadriparesis following anterior cervical discectomy, with normal perioperative somatosensory evoked potentials

“…Recently, however, two cases of postoperative paraplegia have been reported in which perioperative recordings of mixed peripheral nerve action potentials to spinal cord stimulation-mainly if not entirely reflecting antidromic activation of sensory tractswere substantially unchanged. 3 In a series of operations for thoracic vertebrectomy, 4 the incidence of SEP false negatives was reported to be as high as 9%, suggesting that SEP monitoring may sometimes provide an inadequate safeguard.…”