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

Abstract

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.

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

“…For this study, the methods of examination by applying the multimodal intraoperative monitoring as well as the anaesthesia protocol are described by Sutter et al [9,10]. The intraoperative monitoring was performed by the first two authors, experienced neurophysiologists specially trained in the different methods of MIOM.…”

“…All 409 patients underwent spinal surgery between March 2000 and December 2005 and were selected from a large population of 11,536 patients who received spine surgery during the study period. The exclusion criteria are reported elsewhere [9]. All patients underwent preoperative clinical examination by the surgical spine team which included additional neurological and electrophysiological examinations by the first two authors.…”

Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients

“…The general inclusion and exclusion criteria, and the method of examination (MIOM) as well as the anaesthesia protocol have been described by Sutter et al [9,10]. All MIOMs were performed by experienced neurophysiologists who are specially trained in different methods of MIOM.…”

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

“…Sutter et al [19] employed CMAP in 1,006 of the 1,017 monitored cases, reporting the average number of channels to be 2.6 pairs (5.2 channels). 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).…”

“…Accordingly, its usefulness has been reported by a large number of authors. Additionally, the importance of multi-modality monitoring or combinations of at least two of the above methods rather than single-modality approaches has been pointed out in numerous reports [9,19]. No previous report, however, has focused on the number of channels used in CMAP.…”