A method of monitoring function in corticospinal pathways during scoliosis surgery with a note on motor conduction velocities.

Boyd, Stewart; Rothwell, John C.; Cowan, Jennifer E.; Webb, P. J.; Morley, Timothy; Asselman, P.; Marsden, C. D.

doi:10.1136/jnnp.49.3.251

Cited by 317 publications

(84 citation statements)

References 18 publications

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“…The introduction of transcranially motor evoked potentials (MEPs) represented a significant step forward for intraoperative assessment of motor pathway function in spine surgery [1][2][3][4][5][6][7]. Two methodologies have been developed to elicit MEPs by transcranial electrical stimulation [7]:…”

Section: Introductionmentioning

confidence: 99%

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Relevance of intraoperative D wave in spine and spinal cord surgeries

2012

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Purpose The combined recordings of epidural-(D wave) and muscle motor evoked potentials (m-MEPs) have been proposed in many studies in intramedullary spinal cord tumour (IMSCT) surgery, although not all agree. Furthermore, the usefulness of the intraoperative monitoring of motor systems using these methods in other types of spine surgery has not yet been clearly confirmed. The aim of this study is to test the impact of intraoperative D wave on the monitorability and motor outcome in spine surgery. Methods Intraoperative recording of posterior tibial nerve somatosensory potentials, lower limb m-MEPs (LLmMEPs) and epidurally recorded D wave caudally to the surgical level was attempted in a total of 103 spine and spinal cord surgeries (23 IMSCT, 55 extramedullary spinal cord tumours and 25 myelopathies). Results There was a 97.1 %, overall monitorability where at least 1 of the 3 modalities was applicable in 100 surgical procedures. Baseline LLm-MEPs were recorded bilaterally in 85 cases and unilaterally in 11. A caudal D wave was recorded in 97 cases. Transient, or persistent intraoperative modifications occurred in 14/23 IMSCT, 5/55 extramedullary spinal cord tumours and in 2/25 myelopathies. The presence of a persistent stable caudal D wave was predictive of a good motor outcome even when the LL-MEPs were absent and/or when lost during surgery.Conclusions Not only is intraoperative D wave recording to be considered mandatory in IMSCT surgery but it should also be attempted in other types of spine/spinal cord surgeries.

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Section: Introductionmentioning

confidence: 99%

“…Recording the D wave directly from the epidural space (e-MEPs; in this study e-MEPs and D wave are used as synonyms) evoked by a single electrical shock (single pulse technique) [1,2]; 2. Recording of MEPs in limb muscles (m-MEPs) elicited by a short train of electrical stimuli (multipulse technique) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Relevance of intraoperative D wave in spine and spinal cord surgeries

2012

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“…The same study showed the rate of true positive SEP of 0.423% but these findings did not prevent a neurological deficit. It is a well-established fact [3,4,13] that SEP alone are not a reliable tool for assessment of the descending motor pathways: damage will therefore not be primarily recognised by SEP. After basic physiological research in the 1950s [14] motor evoked potentials (MEP) with spinal cord recording were introduced for clinical diagnostic examinations and for monitoring scoliosis surgery [1] in the 1980s. Tamaki [17] and Kurokawa [9] introduced direct spinal cord stimulation and recording techniques spinal cord evoked potentials (SCEP) in the early 1970s.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2007

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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.

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“…By any means, this motor-related potential recorded from the spinal cord was employed as an indicator of the conductive ability of the spinal cord [32,33]. Presently, this method is widely accepted as routine by many researchers and has been intensively studied by Deletis and his group [34].…”

Section: Motor Tract Monitoringmentioning

confidence: 99%