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Scoliosis and Spinal Disorders
Published in: Scoliosis and Spinal Disorders 1/2018

Open Access 01-12-2018 | Research

Systematic re-evaluation of intraoperative motor-evoked potential suppression in scoliosis surgery

Authors: Yew Long Lo, Yam Eng Tan, Sitaram Raman, Adeline Teo, Yang Fang Dan, Chang Ming Guo

Published in: Scoliosis and Spinal Disorders | Issue 1/2018

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Abstract

Background

Motor- (MEP) and somatosensory-evoked potentials (SSEP) are susceptible to the effects of intraoperative environmental factors.

Methods

Over a 5-year period, 250 patients with adolescent idiopathic scoliosis (AIS) who underwent corrective surgery with IOM were retrospectively analyzed for MEP suppression (MEPS).

Results

Our results show that four distinct groups of MEPS were encountered over the study period. All 12 patients did not sustain any neurological deficits postoperatively. However, comparison of groups 1 and 2 suggests that neither the duration of anesthesia nor speed of surgical or anesthetic intervention were associated with recovery to a level beyond the criteria for MEPS. For group 3, spontaneous MEPS recovery despite the lack of surgical intervention suggests that anesthetic intervention may play a role in this process. However, spontaneous MEPS recovery was also seen in group 4, suggesting that in certain circumstances, both surgical and anesthetic intervention was not required. In addition, neither the duration of time to the first surgical manoeuver nor the duration of surgical manoeuver to MEPS were related to recovery of MEPS. None of the patients had suppression of SSEPs intraoperatively.

Conclusion

This study suggests that in susceptible individuals, MEPS may rarely occur unpredictably, independent of surgical or anesthetic intervention. However, our findings favor anesthetic before surgical intervention as a proposed protocol. Early recognition of MEPS is important to prevent false positives in the course of IOM for spinal surgery.
Literature
1.
Calancie B, Klose KJ, Baier S, et al. Isoflurane-induced attenuation of motor evoked potentials caused by electrical motor cortex stimulation during surgery. J Neurosurg. 1991;74:897–904.CrossRefPubMed
2.
Liu EH, Wong HK, Chia CP, Lim HJ, Chen ZY, Lee TL. Effects of isoflurane and propofol on cortical somatosensory evoked potentials during comparable depth of anesthesia as guided by bispectral index. Br J Anaesth. 2005;94(2):193–7.CrossRefPubMed
3.
Freye E, Hartung E, Schenk GK. Somatosensory-evoked potentials during block of surgical stimulation with propofol. Br J Anaesth. 1989;63:357–9.CrossRefPubMed
4.
Nuwer M. Spinal cord monitoring. In: Evoked potential monitoring in the operating room. New York: Raven Press; 1986. p. 49–101.
5.
MacDonald DB, Al Zayed Z, Khoudeir I, Stigsby B. Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine (Phila Pa 1976). 2003;28:194–203.CrossRef
6.
Lyon R, Feiner J, Lieberman JA. Progressive suppression of motor evoked potentials during general anesthesia: the phenomenon of “anesthetic fade”. J Neurosurg Anesthesiol. 2005;17:13–9.PubMed
7.
Holdefer RN, Anderson C, Furman M, Sangare Y, Slimp JC. A comparison of the effects of desflurane versus propofol on transcranial motor-evoked potentials in pediatric patients. Childs Nerv Syst. 2014;30:2103–8.CrossRefPubMed
8.
Liu HY, Zeng HY, Cheng H, Wang MR, Qiao H, Han RQ. Comparison of the effects of etomidate and propofol combined with remifentanil and guided by comparable BIS on transcranial electrical motor-evoked potentials during spinal surgery. J Neurosurg Anesthesiol. 2012;24:133–8.CrossRefPubMed
9.
Lo Y, Dan Y, Tan Y, Teo A, Tan S, Yue W, Guo C, Fook-Chong S. Clinical and physiological effects of transcranial electrical stimulation position on motor evoked potentials in scoliosis surgery. Scoliosis. 2010;23(5):3.CrossRef
10.
Lo YL, Dan YF, Tan YE, Nurjannah S, Tan SB, Tan CT, Raman S. Intraoperative motor-evoked potential monitoring in scoliosis surgery: comparison of desflurane/nitrous oxide with propofol total intravenous anesthetic regimens. J Neurosurg Anesthesiol. 2006;18(3):211–4.CrossRefPubMed
11.
Kalkman CJ, ten Brink SA, Been HD, Bovill JG. Variability of somatosensory cortical evoked potentials during spinal surgery. Effects of anesthetic technique and high-pass digital filtering. Spine (Phila Pa 1976). 1991;16:924–9.CrossRef
12.
Maurette P, Simeon F, Castagnera L, Esposito J, Macouillard G, Heraut LA. Propofol anaesthesia alters somatosensory evoked cortical potentials. Anaesthesia. 1988;43(S):44–5.CrossRefPubMed
13.
Woodforth IJ, Hicks RG, Crawford MR, Stephen JP, Burke D. Depression of I waves in corticospinal volleys by sevoflurane, thiopental, and propofol. Anesth Analg. 1999;89:1182–7.CrossRefPubMed
14.
Antkowiak B. Different actions of general anesthetics on the firing patterns of neocortical neurons mediated by the GABA(A) receptor. Anesthesiology. 1999;91:500–11.CrossRefPubMed
15.
Kakinohana M, Fuchigami T, Nakamura S, Kawabata T, Sugahara K. Propofol reduces spinal motor neuron excitability in humans. Anesth Analg. 2002;94:1586–8.PubMed
16.
Tamkus AA, Rice KS, McCaffrey MT. Perils of intraoperative neurophysiological monitoring: analysis of “false-negative” results in spine surgeries. Spine J. 2018;18:276–84.CrossRefPubMed
17.
Macdonald DB, Skinner S, Shils J, Yingling C. American Society of Neurophysiological Monitoring. Intraoperative motor evoked potential monitoring—a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol. 2013;124:2291–316.CrossRefPubMed
18.
MacDonald DB, Janusz M. An approach to intraoperative neurophysiologic monitoring of thoracoabdominal aneurysm surgery. J Clin Neurophysiol. 2002;19:43–54.CrossRefPubMed
19.
Calancie B, Molano MR. Alarm criteria for motor-evoked potentials: what’s wrong with the “presence-or-absence” approach? Spine. 2008;33:406–14.CrossRefPubMed
20.
Macdonald DB, Al Zayed Z, Al Saddigi A. Four-limb muscle motor evoked potential and optimized somatosensory evoked potential monitoring with decussation assessment: results in 206 thoracolumbar spine surgeries. Eur Spine J. 2007;16(Suppl 2):S171–87.CrossRefPubMed
Metadata
Title
Systematic re-evaluation of intraoperative motor-evoked potential suppression in scoliosis surgery
Authors
Yew Long Lo
Yam Eng Tan
Sitaram Raman
Adeline Teo
Yang Fang Dan
Chang Ming Guo
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Scoliosis and Spinal Disorders / Issue 1/2018
Electronic ISSN: 2397-1789
DOI
https://doi.org/10.1186/s13013-018-0161-3

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