Characterization of Neurophysiologic Alerts During Anterior Cervical Spine Surgery

Lee, Joon Y.; Hilibrand, Alan S.; Lim, Moe R.; Zavatsky, Joseph M.; Zeiller, Steven C.; Schwartz, Daniel M.; Vaccaro, Alexander R.; Anderson, D. Greg; Albert, Todd J.

doi:10.1097/01.brs.0000228724.01795.a2

Cited by 113 publications

(88 citation statements)

References 11 publications

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“…According to other studies, 2,6,17 the definition of false-positive was based on neurological "events." However, our definition of false-positive was based on neurological de- terioration.…”

Section: Discussionmentioning

confidence: 99%

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A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research

Kobayashi

Matsuyama

Shinomiya

et al. 2014

SPI

118

103

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Object Although multimodal intraoperative spinal cord monitoring provides greater accuracy, transcranial electrical stimulation motor evoked potential (TcMEP) monitoring became the gold standard for intraoperative spinal cord monitoring. However, there is no definite alarm point for TcMEPs because a multicenter study is lacking. Thus, based on their experience with 48 true-positive cases (that is, a decrease in potentials followed by a new neurological motor deficit postoperatively) encountered between 2007 and 2009, the authors set a 70% decrease in amplitude as the alarm point for TcMEPs. Methods A total of 959 cases of spinal deformity, spinal cord tumor, and ossification of the posterior longitudinal ligament (OPLL) treated between 2010 and 2012 are included in this prospective multicenter study (18 institutions). These institutions are part of the Japanese Society for Spine Surgery and Related Research monitoring working group and the study group on spinal ligament ossification. The authors prospectively analyzed TcMEP variability and pre- and postoperative motor deficits. A 70% decrease in amplitude was designated as the alarm point. Results There were only 2 false-negative cases, which occurred during surgery for intramedullary spinal cord tumors. This new alarm criterion provided high sensitivity (95%) and specificity (91%) for intraoperative spinal cord monitoring and favorable accuracy, except in cases of intramedullary spinal cord tumor. Conclusions This study is the first prospective multicenter study to investigate the alarm point of TcMEPs. The authors recommend the designation of an alarm point of a 70% decrease in amplitude for routine spinal cord monitoring, particularly during surgery for spinal deformity, OPLL, and extramedullary spinal cord tumor.

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Section: Discussionmentioning

confidence: 99%

“…The TcMEPs yielded a sensitivity of 75% and a specificity of 84%. Lee et al 6 reported a 60% amplitude criterion in 1445 anterior cervical surgeries. There were 267 TcMEP alerts (18.4%) and only 2 neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research

Kobayashi

Matsuyama

Shinomiya

et al. 2014

SPI

118

103

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“…12 Two years later, the same group reported on their experience in a much larger cohort of patients. 15 This manuscript described the results of multimodality monitoring in 1445 patients undergoing ventral cervical surgery. Two hundred and sixty-seven patients were reported to have had either minor or major EP alerts, with the criteria for a major alert being identical to the criteria described above.…”

Section: 29mentioning

confidence: 99%

“…Two hundred and sixty-seven patients were reported to have had either minor or major EP alerts, with the criteria for a major alert being identical to the criteria described above. 15 Major EP alerts occurred in 16% of operations performed for CSM. Of the 93 major alerts in the CSM population, 44 occurred during surgery, 25 occurred during shoulder taping, and 13 occurred during neck taping.…”

Section: 29mentioning

confidence: 99%

Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy

Resnick¹,

Anderson

Kaiser

et al. 2009

SPI

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Object The objective of this systematic review was to use evidence-based medicine to examine the diagnostic and therapeutic utility of intraoperative electrophysiological (EP) monitoring in the surgical treatment of cervical degenerative disease. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to cervical spine surgery and EP monitoring. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). 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 The reliance on changes in EP monitoring as an indication to alter a surgical plan or administer steroids has not been observed to reduce the incidence of neurological injury during routine surgery for cervical spondylotic myelopathy or cervical radiculopathy (Class III). However, there is an absence of study data examining the benefit of altering a surgical plan due to EP changes. Conclusions Although the use of EP monitoring may serve as a sensitive means to diagnose potential neurological injury during anterior spinal surgery for cervical spondylotic myelopathy, the practitioner must understand that intraoperative EP worsening is not specific—it may not represent clinical worsening and its recognition does not necessarily prevent neurological injury, nor does it result in improved outcome (Class II). Intraoperative improvement in EP parameters/indices does not appear to forecast outcome with reliability (conflicting Class I data).

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“…LR between 1 and 2 and between 0.5-1 rarely alter pretest probability. 6 Despite traditional spinal IOM literature suggests that NIOM is effective in identifying patients at a high risk for sustaining new spinal cord injuries [7][8][9][10][11][12][13][14][15] as well as animal research has supported human experience, [16][17][18] there is a heterogeneity in IOM services and this should be reviewed to see what accounts for the difference in false-positive and false-negative cases in the literature.…”

Section: Resultsmentioning

confidence: 99%

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Characterization of Neurophysiologic Alerts During Anterior Cervical Spine Surgery

Cited by 113 publications

References 11 publications

A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research

A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research

Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy

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