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01-10-2016 | Original Article

Intra-operative MEP monitoring can work well in the patients with neural axis abnormality

Authors: Shujie Wang, Qianyu Zhuang, Jianguo Zhang, Ye Tian, Hong Zhao, Yipeng Wang, Yu Zhao, Shugang Li, Xisheng Weng, Guixing Qiu, Jianxiong Shen

Published in: European Spine Journal | Issue 10/2016

Abstract

Purpose

To explain the intra-operative transcranial motor evoked potential (MEP) monitoring can work well in patients with neural axis abnormality (NAA).

Methods

One hundred eighteen consecutive NAA and 334 adolescent idiopathic scoliosis (AIS) patients who underwent spinal deformity surgery between June 2010 and April 2013 in our spine center were included. The MEP data including the success rate of obtaining a baseline, amplitude, sensitivity and specificity were analyzed.

Results

High-efficiency MEPs baseline could be obtained in 117/118 NAA (74 congenital scoliosis, 32 neuromuscular scoliosis, 8 adult scoliosis, 3 congenital kyphoscoliosis and 1 neurofibromatosis scoliosis) and 334 AIS cases. They had an approximate level in success rate of MEPs baseline (99.2 vs. 99.7 %) and MEPs amplitude (317 μV, n = 118; vs. 312 μV, n = 334). The sensitivity and specificity for MEP were 100 and 98.2 % in patients with NAA. And the MEPs amplitude value fitted positive-skewed distribution in both of NAA and AIS.

Conclusions

Intraoperative MEP monitoring can be used accurately and satisfactorily in NAA patients and show no difference compared with AIS.

Potenza V, Weinstein SL, Neyt JG (1998) Dysfunction of the spinal cord during spinal arthrodesis for scoliosis: recommendations for early detection and treatment. A case report. J Bone Joint Surg Am 80:1679–1683PubMed

El-Hawary R, Sucato DJ, Sparagana S, McClung A, Van Allen E, Rampy P (2006) Spinal cord monitoring in patients with spinal deformity and neural axis abnormalities—a comparison with adolescent idiopathic scoliosis patients. Spine 31:E698–E706. doi:10.1097/01.brs.0000232707.98076.37 CrossRefPubMed

Gupta P, Lenke LG, Bridwell KH (1998) Incidence of neural axis abnormalities in infantile and juvenile patients with spinal deformity. Is a magnetic resonance image screening necessary? Spine 23:206–210CrossRefPubMed

Malhotra NR, Shaffrey CI (2010) Intraoperative electrophysiological monitoring in spine surgery. Spine 35:2167–2179. doi:10.1097/BRS.0b013e3181f6f0d0 CrossRefPubMed

Langeloo DD, Journee HL, Polak B, de Kleuver M (2001) A new application of TCE-MEP: spinal cord monitoring in patients with severe neuromuscular weakness undergoing corrective spine surgery. J Spinal Disord 14:445–448CrossRefPubMed

Nair MN, Ramakrishna R, Song K, Kinney G, Slimp J, Ko AL, Avellino AM (2010) Human motor evoked potential responses following spinal cord transection: an in vivo study. Neurosurg Focus 29:E4. doi:10.3171/2010.3.FOCUS09201 CrossRefPubMed

Feng B, Qiu GX, Shen JX, Zhang JG, Tian Y, Li SG, Zhao H, Zhao Y (2012) Impact of multimodal intraoperative monitoring during surgery for spine deformity and potential risk factors for neurological monitoring changes. J Spinal Disord Tech 25:E87–E93. doi:10.1097/Bsd.0b013e31824d2a2f CrossRef

Deletis V, Sala F (2008) Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts. Clin Neurophysiol 119:248–264. doi:10.1016/j.clinph.2007.09.135 CrossRefPubMed

Hayashi H, Kawaguchi M, Yamamoto Y, Inoue S, Koizumi M, Ueda Y, Takakura Y, Furuya H (2008) Evaluation of reliability of post-tetanic motor-evoked potential monitoring during spinal surgery under general anesthesia. Spine 33:E994–E1000. doi:10.1097/Brs.0b013e318188adfc CrossRefPubMed

10.

Lo YL, Dan YF, Tan YE, Fook-Chong S, Tan SB, Tan CT, Raman S (2006) Intraoperative monitoring study of ipsilateral motor evoked potentials in scoliosis surgery. Eur Spine J 15(Suppl 5):656–660. doi:10.1007/s00586-006-0190-0 CrossRefPubMedPubMedCentral

11.

Schwartz DM, Sestokas AK, Dormans JP, Vaccaro AR, Hilibrand AS, Flynn JM, Li PM, Shah SA, Welch W, Drummond DS, Albert TJ (2011) Transcranial electric motor evoked potential monitoring during spine surgery: is it safe? Spine 36:1046–1049. doi:10.1097/BRS.0b013e3181ecbe77 CrossRefPubMed

12.

Calancie B, Harris W, Broton JG, Alexeeva N, Green BA (1998) “Threshold-level” multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring. J Neurosurg 88:457–470. doi:10.3171/jns.1998.88.3.0457 CrossRefPubMed

13.

Krammer MJ, Wolf S, Schul DB, Gerstner W, Lumenta CB (2009) Significance of intraoperative motor function monitoring using transcranial electrical motor evoked potentials (MEP) in patients with spinal and cranial lesions near the motor pathways. Br J Neurosurg 23:48–55. doi:10.1080/02688690802563349 CrossRefPubMed

14.

Hsu B, Cree AK, Lagopoulos J, Cummine JL (2008) Transcranial motor-evoked potentials combined with response recording through compound muscle action potential as the sole modality of spinal cord monitoring in spinal deformity surgery. Spine 33:1100–1106. doi:10.1097/BRS.0b013e31816f5f09 CrossRefPubMed

15.

Calancie B, Harris W, Brindle GF, Green BA, Landy HJ (2001) Threshold-level repetitive transcranial electrical stimulation for intraoperative monitoring of central motor conduction. J Neurosurg 95:161–168PubMed

16.

Wilson-Holden TJ, Padberg AM, Lenke LG, Larson BJ, Bridwell KH, Bassett GS (1999) Efficacy of intraoperative monitoring for pediatric patients with spinal cord pathology undergoing spinal deformity surgery. Spine 24:1685–1692CrossRefPubMed

17.

Hoving EW, Haitsma E, Ophuis CMCO, Journee HL (2011) The value of intraoperative neurophysiological monitoring in tethered cord surgery. Childs Nerv Syst 27:1445–1452. doi:10.1007/s00381-011-1471-4 CrossRefPubMedPubMedCentral

18.

Langeloo DD, Lelivelt A, Louis Journee H, Slappendel R, de Kleuver M (2003) Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine 28:1043–1050. doi:10.1097/01.BRS.0000061995.75709.78 PubMed

19.

Kawaguchi M, Sakamoto T, Inoue S, Kakimoto M, Furuya H, Morimoto T, Sakaki T (2000) Low dose propofol as a supplement to ketamine-based anesthesia during intraoperative monitoring of motor-evoked potentials. Spine 25:974–979. doi:10.1097/00007632-200004150-00013 CrossRefPubMed

20.

Nathan N, Tabaraud F, Lacroix F, Moulies D, Viviand X, Lansade A, Terrier G, Feiss P (2003) Influence of propofol concentrations on multipulse transcranial motor evoked potentials. Br J Anaesth 91:493–497CrossRefPubMed

21.

Deiner SG, Kwatra SG, Lin HM, Weisz DJ (2010) Patient characteristics and anesthetic technique are additive but not synergistic predictors of successful motor evoked potential monitoring. Anesth Analg 111:421–425. doi:10.1213/Ane.0b013e3181e41804 CrossRefPubMed

22.

Moller AR, Ansari S, Cohen-Gadol AA (2011) Techniques of intraoperative monitoring for spinal cord function: their past, present, and future directions. Neurol Res 33:363–370. doi:10.1179/016164110x12807570510130 CrossRefPubMed

23.

Eggspuehler A, Sutter MA, Grob D, Jeszenszky D, Dvorak J (2007) Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients. Eur Spine J 16(Suppl 2):S188–S196. doi:10.1007/s00586-007-0427-6 CrossRefPubMed

24.

Pastorelli F, Di Silvestre M, Plasmati R, Michelucci R, Greggi T, Morigi A, Bacchin MR, Bonarelli S, Cioni A, Vommaro F, Fini N, Lolli F, Parisini P (2011) The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring. Eur Spine J 20(Suppl 1):S105–S114. doi:10.1007/s00586-011-1756-z CrossRefPubMed

25.

Quraishi NA, Lewis SJ, Kelleher MO, Sarjeant R, Rampersaud YR, Fehlings MG (2009) Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine 34:1504–1512. doi:10.1097/BRS.0b013e3181a87b66 CrossRefPubMed

26.

Schwartz DM, Auerbach JD, Dormans JP, Flynn J, Drummond DS, Bowe JA, Laufer S, Shah SA, Bowen JR, Pizzutillo PD, Jones KJ, Drummond DS (2007) Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am 89:2440–2449. doi:10.2106/JBJS.F.01476 CrossRefPubMed

27.

Fehlings MG, Brodke DS, Norvell DC, Dettori JR (2010) The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? Spine 35:S37–S46. doi:10.1097/BRS.0b013e3181d8338e CrossRefPubMed

28.

Muchow RD, McClung A, Rampy P, Van Allen E, Sparagana S, Sucato DJ (2013) Spinal cord monitoring with transcranial motor evoked potentials in patients with neural axis abnormalities undergoing spinal deformity surgery. Spine Deform 1:205–210CrossRef

29.

Sala F, Palandri G, Basso E, Lanteri P, Deletis V, Faccioli F, Bricolo A (2006) Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery 58:1129–1143. doi:10.1227/01.NEU.0000215948.97195.58 (discussion 1129–1143) CrossRefPubMed

Title: Intra-operative MEP monitoring can work well in the patients with neural axis abnormality
Authors: Shujie Wang
Qianyu Zhuang
Jianguo Zhang
Ye Tian
Hong Zhao
Yipeng Wang
Yu Zhao
Shugang Li
Xisheng Weng
Guixing Qiu
Jianxiong Shen
Publication date: 01-10-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 10/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4205-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Intra-operative MEP monitoring can work well in the patients with neural axis abnormality

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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