Comparison of intraoperative neurophysiologic monitoring outcomes between cervical and thoracic spine surgery

Wang, Shujie; Tian, Yuan; Lin, Xiangquan; Ren, Zhifu; Zhao, Yu; Zhai, Jiliang; Zhang, Xiaojuan; Zhao, Yuqian; Dong, Yingyue; Zhao, Congran; Tian, Ye

doi:10.1007/s00586-017-5194-4

Cited by 17 publications

(13 citation statements)

References 30 publications

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“…32 In the majority of previous studies, anesthesia maintenance was only based on hemodynamic response. 19 In our study, anesthesia maintenance was under the guidance of BIS, because we need adequate and equivalent depth of anesthesia to avoid the effects brought by the anesthesia fluctuation on IONM, not just in preventing awareness. 33 There were four patients developed into permanent neurological dysfunction, which presented in Table 5.…”

Section: Comparison Of Muscle Strength Of the Three Subgroupsmentioning

confidence: 98%

The Prognostic Value of Intraoperative Neuromonitoring by Combining Somatosensory- and Motor-Evoked Potentials for Thoracic Spinal Decompression Surgery in Patients with Neurological Deficit

Liu

Dong

et al. 2021

Spine

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Study Design. Retrospective study. Objective. To explore a relation between somatosensory-and motor-evoked potential (SEPs, MEPs) and corresponding thoracic cord function for thoracic spinal decompression surgery (TSDS) in patients with neurological deficit. Summary of Background Data. Although SEPs and MEPs monitoring has been developed as an essential technique in spinal surgery. There are limited data on the reliability of using SEPs and MEPs for TSDS and its prognosis. Methods. One hundred twenty patients underwent TSDS in our hospital, 91 patients completed the trial. All the patients were divided into three subgroups according to the changes of MEPs and SEPs: neither SEPs nor MEP deteriorated -. Simply MEP deteriorated and both SEPs and MEP deteriorated -. Bispectral (BIS) was used to monitor the depth of sedation, which ranged from 40 to 60 by varying the infusion speed of anesthetics. The pre-and postoperative spinal function was assessed by muscle strength and Japanese Orthopaedic Association (JOA) score at three time points:1) before surgery; 2) immediately after general anesthesia recovery; 3) after 3-month follow-up. Results. Sixty-nine cases showed neither SEPs nor MEP deteriorated-, 10 cases showed only MEP deteriorated, and 12 cases showed both SEPs and MEP deteriorated-. The patients in the group where neither SEPs nor MEP deteriorated had the best recovery of the extremity muscle strength, the shortest recovery time (8.10 AE 1.60, P < 0.05), and toe movement time (8.50 AE 1.60, P < 0.05). There is a strong correlation between SEPs variability ratio at T4 time point and JOA recovery ratio (JOA RR) in the 3-month follow-up. Conclusion. Combined SEPs and MEPs monitoring are important for TSDS in patients with neurological deficit and it is helpful for evaluating postoperative prognosis. It is more accurate to record SEPs at T4 time point to predict the patients' prognosis.

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Section: Comparison Of Muscle Strength Of the Three Subgroupsmentioning

confidence: 98%

The Prognostic Value of Intraoperative Neuromonitoring by Combining Somatosensory- and Motor-Evoked Potentials for Thoracic Spinal Decompression Surgery in Patients with Neurological Deficit

Liu

Dong

et al. 2021

Spine

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“…Even slight traction during surgery may have serious consequences. Intraoperative somatosensory evoked potential (SSEP) monitoring can reflect the condition of the spinal cord in time and help to increase the safety of the operation [4,6,21,22]. In this study, one patient who underwent T2–T6 decompression had postoperative neurological deterioration, and the lower limb muscle strength decreased by two levels when compared with that before surgery.…”

Section: Discussionmentioning

confidence: 95%

Benefits and Risks of Subsection Laminectomy with Pedicle Screw Fixation for Ossification of the Ligamentum Flavum of the Thoracic Spine: A Retrospective Study of 30 Patients

et al. 2019

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BackgroundThis study aimed to evaluate the effectiveness of subsection laminectomy with pedicle screw fixation (SLPF) for the treatment of ossification of the ligamentum flavum of the thoracic spine.Material/MethodsThirty patients (age, 40–71 years) with ossification of the ligamentum flavum of the thoracic spine underwent SLPF (13 men, 17 women). Operative time, intraoperative blood loss, preoperative and postoperative change in thoracic kyphosis, and perioperative complications were recorded. The Japanese Orthopedic Association (JOA) score for severity of myelopathy and the American Spinal Injury Association (ASIA) motor and sensory impairment scale were used before and after surgery.ResultsMean operative time for SLPF was 208.4±38.3 min and mean intraoperative blood loss was 689.3±171.7 ml. The mean JOA score significantly increased from 5.7±1.9 before surgery to 8.8±2.2 at one month after surgery and 9.3±2.7 at the last follow-up (P<0.01). Postoperative improvement in neurological function increased by 68.3±14.4%. The postoperative ASIA grades significantly improved compared with the preoperative grades (P<0.01). The mean local Cobb angle significantly decreased from 17.8±4.3° before surgery to 15.4±3.6° at one month after surgery and 15.8±3.8° at the last follow-up (P<0.01). Three patients (10%) had operative cerebrospinal fluid (CSF) leak. Postoperatively, one patient had neurological deterioration, two patients had deep venous thrombosis (DVT), and one patient developed a wound infection.ConclusionsSLPF was an effective procedure for the treatment of ossification of the ligamentum flavum of the thoracic spine.

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“…Surgery for idiopathic scoliosis is similar to TTK involving high-risk procedures of screw-implant and correction [24]. With aggressive alarm criteria, an excellent sensitivity of 100% and speci city of 89.3% were achieved when multi-modal IONM with SSEP and MEP were performed in thoracic decompressive surgery [25]. Though, the e cacy of multi-modal IONM varies in different surgery type, it performs better than single modal IONM.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Multi-Modal Intra-Operative Neurophysiological Monitor in Corrective Surgery for Thoracic Tuberculosis with Kyphosis

Huang

Gong

et al. 2021

Preprint

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Background This study assesses performance and utility of motor evoked potentials and somatosensory evoked potentials during corrective surgery to thoracic tuberculosis with kyphosis (TTK), as well as corresponding risk factors. Methods Patients diagnosed with TTK and underwent TTK corrective surgery from 2012 to 2018 were included. Relevant Data were retrospectively collected. Measures of intraoperative neurophysiological monitoring (IONM) performance were calculated. A receiver operating characteristic (ROC) curve and area under ROC curve (AUC) were deployed to identify the diagnostic accuracy of potential recovery. Univariate and multivariate analysis were performed to determine risk factors correlated with IONM alerting. Results 68 patients were included. The mean age was 31.7±20.3 years (3-78 years). IONM alerting occurred in 12 surgeries (12/68, 17.6%), of which 6 were somatosensory evoked potential (SSEP) alerting, 2 motor evoked potential (MEP) alerting, and 4 combinations of both SSEP and MEP. There were 10 posterior vertebral column resections (PVCRs) and 2 pedicle subtraction osteotomies (PSOs) with 1.83±1.19 vertebra resected. Four (4/68, 5.89%) patients were identified with presence of postoperative neurological deficits (PNDs). Calculated measures of performance of MEP and SSEP were as follows: sensitivity of 0.75, specificity of 0.86, positive predictive value (PPV) of 0.25, and negative predictive value (NPV) of 0.98 respectively. The AUC of evoked potential recovery in diagnosing a PND was 0.884. On logistic regression analysis, sever kyphosis was determined as the independent risk factor for IONM alerting. Conclusions Multimodal IONM can benefit 66.7% participants from neural impingement under appropriate intervention after IONM alerting. Corrective surgery in TTK is at risk of spinal injury, especially in severe kyphosis requiring three-column osteotomy.

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Comparison of intraoperative neurophysiologic monitoring outcomes between cervical and thoracic spine surgery

Abstract: The IOM loss between CCM and TCM patients present obvious difference and the sudden MEPs loss associated with spinal decompression need to be taken seriously especially in TCM.

Cited by 17 publications

References 30 publications

The Prognostic Value of Intraoperative Neuromonitoring by Combining Somatosensory- and Motor-Evoked Potentials for Thoracic Spinal Decompression Surgery in Patients with Neurological Deficit

The Prognostic Value of Intraoperative Neuromonitoring by Combining Somatosensory- and Motor-Evoked Potentials for Thoracic Spinal Decompression Surgery in Patients with Neurological Deficit

Benefits and Risks of Subsection Laminectomy with Pedicle Screw Fixation for Ossification of the Ligamentum Flavum of the Thoracic Spine: A Retrospective Study of 30 Patients

The Utility of Multi-Modal Intra-Operative Neurophysiological Monitor in Corrective Surgery for Thoracic Tuberculosis with Kyphosis

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