The Value of Somatosensory- and Motor-Evoked Potentials in Predicting and Monitoring the Effect of Therapy in Spondylotic Cervical Myelopathy

Bednařík, Josef; Kadaňka, Zdeněk; Voháňka, Stanislav; Stejskal, L; Vlach, O; Schröder, R

doi:10.1097/00007632-199908010-00014

Cited by 73 publications

(33 citation statements)

References 26 publications

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“…The studies described by Bednarik et al 1 and Kadanka and colleagues 3 appear to concern the same group of patients. However, the Bednarik et al study included electrophysiological data in addition to clinical outcome data.…”

Section: Mild Cervical Myelopathymentioning

confidence: 80%

“…The subgroup of 12 patients with severe disability (mean mJOA scale score of 9.5) showed significant improvement after surgical intervention (mean mJOA scale score 10.9 at 2 years postoperatively). 1,3 Because of its small size, this study was powered to have a minimal detectable difference in mJOA scale score of 1.7. With pretreatment mJOA scores starting at ~ 14 out of a possible 18, the level of improvement would have to be 42% (1.7/4.0) for the study to have a detectable a difference; this raises the likelihood of a Type II error.…”

Section: Mild Cervical Myelopathymentioning

confidence: 99%

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Anterior cervical surgery for the treatment of cervical degenerative myelopathy

Matz

Holly

Mummaneni

et al. 2009

SPI

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Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of anterior cervical surgery for the treatment of cervical spondylotic myelopathy (CSM). Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to anterior cervical surgery and CSM. Abstracts were reviewed, and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Mild CSM (modified Japanese Orthopaedic Association [mJOA] scale scores > 12) responds in the short term (3 years) to either surgical decompression or nonoperative therapy (prolonged immobilization in a stiff cervical collar, “low-risk” activity modification or bed rest, and antiinflammatory medications) (Class II). More severe CSM responds to surgical decompression with benefits being maintained a minimum of 5 years and as long as 15 years postoperatively (Class III). Conclusions Treatment of mild CSM may involve surgical decompression or nonoperative therapy for the first 3 years after diagnosis. More severe CSM (mJOA scale score ≤ 12) should be considered for surgery depending upon the individual case. The shortcomings of this systematic review are that the group was not able to determine whether an mJOA scale score of 12 was indicative of a more severe CSM disease course, and whether patients who received nonsurgical treatment for 3 years had a significant probability for clinical deterioration after that time point.

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Section: Mild Cervical Myelopathymentioning

confidence: 80%

Section: Mild Cervical Myelopathymentioning

confidence: 99%

Anterior cervical surgery for the treatment of cervical degenerative myelopathy

Matz

Holly

Mummaneni

et al. 2009

SPI

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“…Authors of various studies have suggested that MEPs, SEPs, and other forms of neurophysiological monitoring may potentially provide prognostic information regarding the clinical outcome of decompression surgery in patients with CSM. 1,4,9,10,12,13 Lyu and colleagues 12 performed preoperative MEPs and SEPs in 39 patients with CSM who had hyperintensity on T2-weighted MR images of the cervical cord and who were to undergo surgical decompression. The authors used pre-and postoperative JOA scale scores 19 and 6-month neurological recovery rates as described by Hirabayashi et al 8 as functional outcome measures.…”

Section: Neurophysiological Functionmentioning

confidence: 99%

“…Bednarik et al 1 divided a group of 61 patients with CSM into 2 groups according to myelopathy severity. Forty-nine patients had mild or moderate myelopathy (mJOA scale score ≥ 12), and 12 had severe myelopathy (mJOA scale score < 12).…”

Section: Neurophysiological Functionmentioning

confidence: 99%

Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy

Holly

Matz

Anderson³

et al. 2009

SPI

107

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Object The objective of this systematic review was to use evidence-based medicine to assess whether clinical factors predict surgical outcomes in patients undergoing cervical surgery. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to clinical preoperative factors. Abstracts were reviewed, and studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Preoperative sensory-evoked potentials may aid in providing prognostic information in selected patients in whom clinical factors do not provide clear guidance (Class II). Age, duration of symptoms, and preoperative neurological function may commonly affect outcome (Class III). Conclusions Age, duration of symptoms, and preoperative neurological function should be discussed with patients when surgical intervention for cervical spondylotic myelopathy is considered. Preoperative sensory-evoked potentials may be considered for patients in whom clinical factors do not provide clear guidance if such information would potentially change therapeutic decisions.

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“…In smaller studies, adults with cervical myelopathy had about a 12% incidence of MEP only alerts (no EMG or SEP changes); these alerts were usually followed by resolution after alterations in anesthetic and surgical management occurred. Nonetheless, the authors believed that the MEP monitoring provided 100% sensitivity and 90% specificity [ 46,47 ] .…”

Section: Application Of Mep Monitoringmentioning

confidence: 99%

Transcranial Motor Evoked Potentials

Jameson

2011

Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

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Motor-evoked potentials (MEPs) are the most recent addition to routine intraoperative neurophysiologic monitoring (IOM). Enthusiastic reports of improved outcomes obtained with the use of somatosenory evoked potential (SEP) monitoring, primarily for scoliosis procedures in children and young adults, were quickly followed by case reports of isolated postoperative motor injury without sensory changes [ 1 ] . These reports reflected the reality of the anatomy and physiology of motor/sensory pathways. MEP and SEP pathways are located in different topographic and vascular regions of the cerebral cortex, brainstem, and spinal cord. Motor functional pathways are more sensitive to ischemic insults than SEP pathways [ 2 ] .

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The Value of Somatosensory- and Motor-Evoked Potentials in Predicting and Monitoring the Effect of Therapy in Spondylotic Cervical Myelopathy

Abstract: Longitudinal evoked potentials showed limited use for evaluating the results of therapy in an individual patient. They could be useful in the group assessment of therapy results and in labeling a subgroup of patients with potentially favorable postsurgical outcome.

Cited by 73 publications

References 26 publications

Anterior cervical surgery for the treatment of cervical degenerative myelopathy

Anterior cervical surgery for the treatment of cervical degenerative myelopathy

Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy

Transcranial Motor Evoked Potentials

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