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

Jones, S. J.; Buonamassa, Simona; Crockard, H. A.

doi:10.1136/jnnp.74.2.273

Cited by 101 publications

(42 citation statements)

References 13 publications

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“…Although the past few years have witnessed the wide use of intraoperative SEPs recording, which has, on the whole, proven to be a reliable mean of monitoring the integrity of the spinal cord during spine and spinal cord surgery, several reports 7,8,[22][23][24][25][26][27] have documented the inadequacy of SEPs when assessing motor pathway functional integrity in the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Somatosensory- and motor-evoked potential monitoring during spine and spinal cord surgery

et al. 2006

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Objectives: Complex spinal surgery carries a significant risk of neurological damage. The aim of this study is to determine the reliability and applicability of multimodality motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) monitoring during spine and spinal cord surgery in our institute. Methods: Recordings of MEPs to multipulse transcranial electrical stimulation (TES) and cortical SEPs were made on 52 patients during spine and spinal cord surgery under propofol/ fentanyl anaesthesia, without neuromuscular blockade. Results: Combined MEPs and SEPs monitoring was successful in 38/52 patients (73.1%), whereas only MEPs from at least one of the target muscles were obtained in 12 patients (23.1%); both MEPs and SEPs were absent in two (3.8%). Significant intraoperative-evoked potential changes occurred in one or both modalities in five (10%) patients. Transitory changes were noted in two patients, whereas three had persistent changes, associated with new deficits or a worsening of the pre-existing neurological disabilities. When no postoperative changes in MEP or MEP/SEP modalities occurred, it was predictive of the absence of new motor deficits in all cases. Conclusion: Intraoperative combined SEP and MEP monitoring is a safe, reliable and sensitive method to detect and reduce intraoperative injury to the spinal cord. Therefore, the authors suggest that a combination of SEP/MEP techniques could be used routinely during complex spine and/or spinal cord surgery.Spinal Cord (2007) 45, 86-91.

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Section: Discussionmentioning

confidence: 99%

Somatosensory- and motor-evoked potential monitoring during spine and spinal cord surgery

et al. 2006

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“…However, because of missing availability and the preference of the surgeon to operate without it, this technique is not used consistently [15]. Despite its proven effectivity, intraoperative monitoring might fail to detect neurofunctional deterioration in some of the cases with the result of false negative findings [13].…”

Section: Discussionmentioning

confidence: 99%

Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome

et al. 2011

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Purpose We demonstrate clinical features, therapy and outcome of 14 patients with symptomatic spinal cavernous malformations (CM). Methods We retrospectively reviewed all patients who underwent microsurgical treatment of symptomatic spinal CM during the last decade in our department through an analysis of our database. Results We analyzed the data of 14 patients (11 females, 3 males) with symptomatic spinal CM in a range of 16-77 years (mean age 47.8 years). Seven patients (50%) experienced significant improvement of their symptoms rapidly after surgery. The remaining seven patients presented new non pre-existing complaints, which improved gradually with a favourable outcome at the last follow-up examination in six cases. Conclusion Microsurgical treatment under perioperative electrophysiological monitoring is justified to prevent severe neurofunctional deterioration in symptomatic spinal CM. Although some of the patients deteriorate after surgery, the symptoms are rapidly declining with a favourable outcome in majority of them.

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“…SSEP carrying information of dorsal column integrity has to be less sensitive to postoperative motor deficit. Hence, cases with serious postoperative deficit in spite of intact SSEP can be found in the previous studies [16][17][18][19][20]. The 'false negative' of SSEP for postoperative neurological deficit need be defined if it is for motor deficit or hypaesthesia before reporting those sensitivity and specificity.…”

Section: Predictability Of Mep and Ssep For Postoperative Motor Deficitmentioning

confidence: 99%

“…Monitoring only SSEP could be tragic in selective cases [16,20]. Deletis et al warned not to allow SSEP alone in intramedullary spinal cord tumor surgery, where traction, coagulation or ultrasonic aspiration can selectively damage either motor or sensory pathways [22].…”

Section: Effectiveness Of Ssep In Patients Without Measurable Mepmentioning

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

Cited by 101 publications

References 13 publications

Somatosensory- and motor-evoked potential monitoring during spine and spinal cord surgery

Somatosensory- and motor-evoked potential monitoring during spine and spinal cord surgery

Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome

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

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