Spinal Cord Monitoring in Patients With Spinal Deformity and Neural Axis Abnormalities

El-Hawary, Ron; Sucato, Daniel J.; Sparagana, Steven; McClung, Anna; Allen, Elizabeth Van; Rampy, Patricia

doi:10.1097/01.brs.0000232707.98076.37

Cited by 27 publications

(12 citation statements)

References 45 publications

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“…In other cases, a warning may lead to alteration of the surgical procedure that may have prevented neurological injury. These results described above are typical of those found in other studies,[11181941434649] some of which are shown in Table 3. In particular, Malhotra[37] suggested the importance of multimodality monitoring in order to increase sensitivity and reduce false positives.…”

Section: Specific Applicationssupporting

confidence: 91%

A review of intraoperative monitoring for spinal surgery

Stecker¹

2012

Surg Neurol Int

101

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Background:Intraoperative neurophysiologic monitoring (IONM) is a technique that is helpful for assessing the nervous system during spine surgery.Methods:This is a review of the field describing the basic mechanisms behind the techniques of IONM. These include the most often utilized trancranial motor evoked potentials (Tc-MEPs), somatosensory evoked potentials (SSEPs), and stimulated and spontaneous EMG activity. It also describes some of the issues regarding practices and qualifications of practitioners.Results:Although the anatomic pathways responsible for the Tc-MEP and SSEP are well known and these clinical techniques have a high sensitivity and specificity, there is little published data showing that monitoring actually leads to improved patient outcomes. It is evident that IONM has high utility when the risk of injury is high, but may be only marginally helpful when the risk of injury is very low. The monitoring team must be well trained, be able to provide the surgeon feedback in real time, and coordinate activities with those of the surgical and anesthesia teams.Conclusions:Although IONM is a valuable technique that provides sensitive and specific indications of neurologic injury, it does have limitations that must be understood. Maintaining a high quality of practice with appropriately trained personnel is critical.

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Section: Specific Applicationssupporting

confidence: 91%

A review of intraoperative monitoring for spinal surgery

Stecker¹

2012

Surg Neurol Int

101

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“…11,17,28,29 Spinal cord monitoring is widely used in surgery for spinal deformity, 23,25,27,30,31,35 but only a few studies have included patients with adolescent idiopathic scoliosis (AIS). 7,18 Studies of intraoperative factors such as operative time, estimated blood loss (EBL), body temperature, and changes in blood pressure are particularly rare in patients who are younger than 20 years and have AIS. Therefore, the purpose of this study was to examine intraoperative Tc-MEP waveform deterioration during posterior corrective fusion for AIS, with the aim of understanding neurophysiological changes during surgery and measures for prevention of waveform deterioration.…”

mentioning

confidence: 99%

Transcranial motor evoked potential waveform changes in corrective fusion for adolescent idiopathic scoliosis

Kobayashi¹,

Imagama²,

Ito³

et al. 2017

PED

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OBJECTIVE Corrective surgery for spinal deformities can lead to neurological complications. Several reports have described spinal cord monitoring in surgery for spinal deformity, but only a few have included patients younger than 20 years with adolescent idiopathic scoliosis (AIS). The goal of this study was to evaluate the characteristics of cases with intraoperative transcranial motor evoked potential (Tc-MEP) waveform deterioration during posterior corrective fusion for AIS. METHODS A prospective database was reviewed, comprising 68 patients with AIS who were treated with posterior corrective fusion in a prospective database. A total of 864 muscles in the lower extremities were chosen for monitoring, and acceptable baseline responses were obtained from 819 muscles (95%). Intraoperative Tc-MEP waveform deterioration was defined as a decrease in intraoperative amplitude of ≥ 70% of the control waveform. Age, Cobb angle, flexibility, operative time, estimated blood loss (EBL), intraoperative body temperature, blood pressure, number of levels fused, and correction rate were examined in patients with and without waveform deterioration. RESULTS The patients (3 males and 65 females) had an average age of 14.4 years (range 11–19 years). The mean Cobb angles before and after surgery were 52.9° and 11.9°, respectively, giving a correction rate of 77.4%. Fourteen patients (20%) exhibited an intraoperative waveform change, and these occurred during incision (14%), after screw fixation (7%), during the rotation maneuver (64%), during placement of the second rod after the rotation maneuver (7%), and after intervertebral compression (7%). Most waveform changes recovered after decreased correction or rest. No patient had a motor deficit postoperatively. In multivariate analysis, EBL (OR 1.001, p = 0.085) and number of levels fused (OR 1.535, p = 0.045) were associated with waveform deterioration. CONCLUSIONS Waveform deterioration commonly occurred during rotation maneuvers and more frequently in patients with a larger preoperative Cobb angle. The significant relationships of EBL and number of levels fused with waveform deterioration suggest that these surgical invasions may be involved in waveform deterioration.

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“…However, the success rates of baseline MEP recording during general anesthesia have remained unsatisfactory, especially in patients with preoperative neurological dysfunction. Recent reports have indicated that the success rates of baseline MEP recording during spinal surgery were 89%-100% and 30%-50% in patients without and with preoperative motor weakness, respectively [12,13]. In our recent study, the success rates of baseline MEP recording were signifi cantly improved by using p-MEP in patients without and with preoperative motor weakness (c-MEP, 74.5% and 51.7%, respectively; p-MEP, 96.1% and 86.2%, respectively) [14].…”

Section: Reliability Of P-mep Monitoringmentioning

confidence: 99%

Recent advances in the monitoring of myogenic motor-evoked potentials: development of post-tetanic motor-evoked potentials

et al. 2008

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Spinal Cord Monitoring in Patients With Spinal Deformity and Neural Axis Abnormalities

Abstract: SCM in patients who have NAA can be more difficult to obtain than in AIS but results in few false positives and does not miss neurologic injury.

Cited by 27 publications

References 45 publications

A review of intraoperative monitoring for spinal surgery

A review of intraoperative monitoring for spinal surgery

Transcranial motor evoked potential waveform changes in corrective fusion for adolescent idiopathic scoliosis

Recent advances in the monitoring of myogenic motor-evoked potentials: development of post-tetanic motor-evoked potentials

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