Comparing Motor-Evoked Potential Characteristics of NEedle versus suRFACE Recording Electrodes during Spinal Cord Monitoring—The NERFACE Study Part I

Gadella, Maria C.; Dulfer, Sebastiaan E.; Absalom, Anthony; Lange, Fiete; Scholtens-Henzen, Carola H. M.; Groen, Rob J. M.; Wapstra, Frits-Hein; Faber, Chris; Tamási, Katalin; Sahinovic, Marko; Drost, Gea

doi:10.3390/jcm12041404

Cited by 7 publications

(10 citation statements)

References 24 publications

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“…The mTc-MEP monitoring method and settings were described in the NERFACE study part I [10]. Surface and subcutaneous needle electrodes were placed at the TA muscles.…”

Section: Muscle-recorded Transcranial Electrical Stimulation Motor Ev...mentioning

confidence: 99%

“…Surface and subcutaneous needle electrodes were placed at the TA muscles. A detailed description of the placement of recording electrodes has been described in the NERFACE study part I [10].…”

Section: Muscle-recorded Transcranial Electrical Stimulation Motor Ev...mentioning

confidence: 99%

“…Anaesthetic management was described in NERFACE study part I [10]. In short, for general anaesthesia, total intravenous anaesthesia (TIVA) using propofol with either sufentanil or remifentanil was used during all surgeries.…”

Section: Anaesthesiamentioning

confidence: 99%

“…In part I of the NERFACE study, mTc-MEP monitoring characteristics were compared between subcutaneous needle and surface recording electrodes [10]. We concluded that both recording electrodes were acceptable for mTc-MEPs for spinal cord monitoring.…”

Section: Introductionmentioning

confidence: 95%

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Use of NEedle Versus suRFACE Recording Electrodes for Detection of Intraoperative Motor Warnings: A Non-Inferiority Trial. The NERFACE Study Part II

Dulfer

Gadella

Tamási

et al. 2023

JCM

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In the NERFACE study part I, the characteristics of muscle transcranial electrical stimulation motor evoked potentials (mTc-MEPs) recorded from the tibialis anterior (TA) muscles with surface and subcutaneous needle electrodes were compared. The aim of this study (NERFACE part II) was to investigate whether the use of surface electrodes was non-inferior to the use of subcutaneous needle electrodes in detecting mTc-MEP warnings during spinal cord monitoring. mTc-MEPs were simultaneously recorded from TA muscles with surface and subcutaneous needle electrodes. Monitoring outcomes (no warning, reversible warning, irreversible warning, complete loss of mTc-MEP amplitude) and neurological outcomes (no, transient, or permanent new motor deficits) were collected. The non-inferiority margin was 5%. In total, 210 (86.8%) out of 242 consecutive patients were included. There was a perfect agreement between both recording electrode types for the detection of mTc-MEP warnings. For both electrode types, the proportion of patients with a warning was 0.12 (25/210) (difference, 0.0% (one-sided 95% CI, 0.014)), indicating non-inferiority of the surface electrode. Moreover, reversible warnings for both electrode types were never followed by permanent new motor deficits, whereas among the 10 patients with irreversible warnings or complete loss of amplitude, more than half developed transient or permanent new motor deficits. In conclusion, the use of surface electrodes was non-inferior to the use of subcutaneous needle electrodes for the detection of mTc-MEP warnings recorded over the TA muscles.

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“…The mTc-MEP monitoring method and settings were described in the NERFACE study part I [10]. Surface and subcutaneous needle electrodes were placed at the TA muscles.…”

Section: Muscle-recorded Transcranial Electrical Stimulation Motor Ev...mentioning

confidence: 99%

Section: Muscle-recorded Transcranial Electrical Stimulation Motor Ev...mentioning

confidence: 99%

Section: Anaesthesiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

See 2 more Smart Citations

Use of NEedle Versus suRFACE Recording Electrodes for Detection of Intraoperative Motor Warnings: A Non-Inferiority Trial. The NERFACE Study Part II

Dulfer

Gadella

Tamási

et al. 2023

JCM

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“…However, it should be remembered that these muscles are surgically incised and retracted in the midline to expose the surgical field during the curvature correction, and a comparison between their preoperative and postoperative function, especially in a short-term follow-up, would be fraught with inevitable iatrogenic structural damage. Hence, the MEP and sEMG recordings using the surface electrodes in the tibialis anterior muscle bilaterally are not only more widely used for pre-and postoperative diagnostic purposes but their activity has also been proven to be precise enough for intraoperative monitoring [40,41].…”

Section: Discussionmentioning

confidence: 99%

Clinical Neurophysiological Methods Verify Improvement in the Motor Neural Transmission in Patients with Surgically Treated Idiopathic Scoliosis in Long-Term Follow-up

Daroszewski,

Huber,

Kaczmarek

et al. 2024

Applied Sciences

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The evaluation of patients after the surgical correction of idiopathic scoliosis in a long-term follow-up with clinical neurophysiological methods has not been presented in detail. This study aimed to compare the results of neurophysiological studies in 45 girls with scoliosis of Lenke types 1–3 performed pre- (T0) and postoperatively, 1 week after surgery (T1) and 6 months after surgery (T2). The parameter values of the surface electromyography while attempting maximal contraction (mcsEMG) and the transcranial motor-evoked potentials (MEPs) recorded in the anterior tibial muscles, as well as the electroneurography (ENG) of the peripheral transmission in the peroneal nerve motor fibers, were compared. The results indicate that efferent neural conduction functioned both centrally and peripherally, and TA muscle function slightly improved immediately after the surgical correction of scoliosis, and further normalization appeared after six months in the long-term follow-up (at p = 0.03). The sEMG recordings indicate that half a year after surgical treatment in IS patients, the TA muscle motor unit recruitment function, as well as the muscle strength evaluated with Lovett’s scale, was comparable to the normal condition. The ENG recording results indicate a gradual reduction in the motor fiber injury symptoms, mainly of the axonal type, in the peroneal nerves. The surgeries also improved the lumbar ventral roots’ neural transmission to a normal functional status. The MEP amplitude parameter values recorded after the surgical scoliosis corrections in T1 indicated a slight improvement in the efferent transmission of neural impulses within the fibers of the spinal tracts; in the long-term T2 observation period, they reached values comparable to those recorded in healthy volunteers, bilaterally. Preoperatively (T0), the results of all the neurophysiological study parameters in the IS patients were asymmetrical at p = 0.036–0.05 and recorded as worse on the concave side, suggesting the lateralization of neurological motor deficits. One week postoperatively (T1), this asymmetry was recorded as gradually reduced, showing almost no difference between the right and left sides six months later (T2). The presented algorithm for the neurophysiological assessments performed in the pre-, intra-, and long-term postoperative periods using the mcsEMG, MEP, and ENG neurophysiological examinations, together with the clinical studies, may help in the comprehensive functional evaluation of the spinal cord tracts and ventral root neural conduction, which allows the detection of the subclinical neurological changes related to scoliosis itself and the consequences of the corrective surgery. Such an evaluation can also be significant in making final decisions regarding IS surgeries and their personalization after attempting conservative treatments with bracing and kinesiotherapy. Neurophysiological studies, as a sensitive biomarker, allowed us to predict and ascertain the final result of IS treatment in the long-term follow-up, which showed the health status of patients as being comparable to that of healthy volunteers.

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Comparison of Motor Evoked Potentials Neuromonitoring Following Pre- and Postoperative Transcranial Magnetic Stimulation and Intraoperative Electrical Stimulation in Patients Undergoing Surgical Correction of Idiopathic Scoliosis

Daroszewski,

Huber,

Kaczmarek

et al. 2023

Preprint

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Neuromonitoring of the efferent nerve impulses transmission in the spinal cord tracts during surgical scoliosis treatment makes it possible to assess whether the functional status is deteriorating, affecting the procedure's safety. Is there any relationship between pre- and intraoperative motor evoked potentials recordings and does idiopathic scoliosis (IS) surgical correction improve directly the spinal efferent transmission? This study aimed to compare the results of surface recorded electromyography (EMG), electroneurography (ENG, M and F-waves), and especially motor evoked potentials (MEP) from tibialis anterior (TA) muscle bilaterally in 353 girls with the right idiopathic scoliosis (types 1A-4C according to Lenke classification). It has not yet been documented whether the results of MEPs recordings induced by transcranial single magnetic stimulus (TMS, pre – and postoperatively) and trains of electrical stimuli (TES; intraoperatively in T0-before surgery, T1 – after pedicle screws implantation, T2 – after scoliosis curvature distraction and derotation following two rods implantation) can be compared for diagnostic verification of improvement of the spinal neural transmission. The study also attempted to determine whether the constant level of optimal anesthesia during the certain surgical steps of scoliosis treatment affects the parameters of MEPs recorded during neuromonitoring procedures. No neurological deficits have been observed postoperatively. Values of amplitudes but not latencies in MEPs recordings evoked with TMS in IS patients compared before and after surgery indicated a slight improvement in the efferent transmission of neural impulses within the fibers of the spinal tracts postoperatively. Results of all neurophysiological studies in IS patients were significantly asymmetrical and recorded worse on the concave side, suggesting greater neurological motor deficits at p=0.04. This asymmetry had been significantly reduced following IS surgery. The surgeries in IS patients brought significant improvement (p=0.04) in parameters of amplitudes of sEMG recordings, however reflecting still the consequences of the neurogenic injury of TA muscle motor units. ENG studies results indicated the symptoms of the axonal type injury in peroneal motor fibers improved only on the concave side at p=0.04 in parallel with the significant improvement of F-waves parameters, which suggests that surgeries might result in the lumbar ventral roots decompression. There were not detected significant differences in amplitudes or latencies of MEPs induced with TMS or TES comparing the parameters recorded preoperatively (one day before surgery) and intraoperatively in T0. The amplitudes of TES evoked MEPs increased gradually at p=0.04 in the subsequent periods (T1 and T2) of observation. The significant reduction of MEPs latency at p=0.05 was observed only at the end of the IS surgery. Studies on the possible connections between the level of anesthesia fluctuations and the required TMS stimulus strength, as well as the MEPs amplitude changes measured in T0-T2 revealed lack of relationships. It is not likely that they could be the factors influencing the efferent transmission in spinal pathways beside the surgical procedures. Considering that MEPs amplitude parameter reflects the number of axons excited from the motor cortex and transmitting the efferent impulses via spinal descending tracts in the white matter, pre- (TMS evoked) and intraoperative (TES evoked) recordings are reliable for evaluating the patient’s neurological status before and during surgical scoliosis correction procedures. The results of this study indicate an agreement between preoperative and early-intraoperative evaluations with these both diagnostic methods. An increase of MEPs amplitude parameters recorded on both sides after scoliosis surgery proves immediate improvement of the total efferent spinal cord transmission. Considering comparative pre- and postoperative sEMG and ENG recordings it can be concluded that surgeries might directly result in the additional lumbar ventral roots decompression. Our results of the tests on the possible variability of the anesthesia level on the parameters of intraoperative recorded MEPs show no clear relationships. We can conclude that MEPs parameters changes are determined by the surgery procedures during neuromonitoring, not the anesthesia conditions if they are kept stable, which influences a decrease in the number of false-positive neuromonitoring warnings. Further studies on a larger population of patients with long-lasting observation postoperatively are required to confirm the presented conclusions on the direct influences of scoliosis surgery on improvement of the motor function in patients with IS.

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Comparing Motor-Evoked Potential Characteristics of NEedle versus suRFACE Recording Electrodes during Spinal Cord Monitoring—The NERFACE Study Part I

Cited by 7 publications

References 24 publications

Use of NEedle Versus suRFACE Recording Electrodes for Detection of Intraoperative Motor Warnings: A Non-Inferiority Trial. The NERFACE Study Part II

Use of NEedle Versus suRFACE Recording Electrodes for Detection of Intraoperative Motor Warnings: A Non-Inferiority Trial. The NERFACE Study Part II

Clinical Neurophysiological Methods Verify Improvement in the Motor Neural Transmission in Patients with Surgically Treated Idiopathic Scoliosis in Long-Term Follow-up

Comparison of Motor Evoked Potentials Neuromonitoring Following Pre- and Postoperative Transcranial Magnetic Stimulation and Intraoperative Electrical Stimulation in Patients Undergoing Surgical Correction of Idiopathic Scoliosis

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