Intraoperative Somatosensory Evoked Potential Monitoring During Cervical Spine Corpectomy Surgery

Khan, Mustafa; Smith, Patrick N.; Balzer, Jeffrey; Crammond, Donald J.; Welch, William C.; Gerszten, Peter C.; Sclabassi, R.J.; Kang, James D.; Donaldson, William F.

doi:10.1097/01.brs.0000200163.71909.1f

Cited by 82 publications

(52 citation statements)

References 35 publications

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“…19 Other studies suggest that use of IONM during cervical spine surgeries can actually misinform the surgeon and result in inaccurate intraoperative findings. 11,18 Alternatively, some researchers argue that IONM contributes to prevention of new postoperative neurological deficits in patients undergoing low-risk cervical spine surgeries. Roh et al reported that somatosensory evoked potential monitoring prompted an intervention for 2.1% of 809 patients consecutively undergoing cervical spine surgery and probably prevented neurological sequelae in 82% of patients for whom an intervention was made.…”

Section: Discussionmentioning

confidence: 99%

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

James

Rughani

Dumont

2014

FOC

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Object In the United States in recent years, a dramatic increase in the use of intraoperative neurophysiological monitoring (IONM) during spine surgeries has been suspected. Myriad reasons have been proposed, but no clear evidence confirming this trend has been available. In this study, the authors investigated the use of IONM during spine surgery, identified patterns of geographic variation, and analyzed the value of IONM for spine surgery cases. Methods In this retrospective analysis, the Nationwide Inpatient Sample was queried for all spine surgeries performed during 2007–2011. Use of IONM (International Classification of Diseases, Ninth Revision, code 00.94) was compared over time and between geographic regions, and its effect on patient independence at discharge and iatrogenic nerve injury was assessed. Results A total of 443,194 spine procedures were identified, of which 85% were elective and 15% were not elective. Use of IONM was recorded for 31,680 cases and increased each calendar year from 1% of all cases in 2007 to 12% of all cases in 2011. Regional use of IONM ranged widely, from 8% of cases in the Northeast to 21% of cases in the West in 2011. Iatrogenic nerve and spinal cord injury were rare; they occurred in less than 1% of patients and did not significantly decrease when IONM was used. Conclusions As costs of spine surgeries continue to rise, it becomes necessary to examine and justify use of different medical technologies, including IONM, during spine surgery.

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Section: Discussionmentioning

confidence: 99%

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

James

Rughani

Dumont

2014

FOC

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“…Intraoperative neurophysiological monitoring techniques include SSEPs 8,16 , TcMEPs 15 can be used to reduce the incidence of neurological deficits after cervical, thoracic and lumbar spinal procedures. SSEPs 16 and TcMEPs 15 monitor the dorsal column and the motor pathways in the spinal cord and reduce neurological deficits after spinal surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure is associated with neurological complications such as worsening of myelopathy 3 , cervical nerve root palsy 15,164,5 , recurrent laryngeal nerve palsy (RLN) 3,6,7 and dysphagia 1,7 . Intraoperative neurophysiological monitoring (IOM) with somatosensory evoked potentials(SSEP) 2,8,9 , transcranial motor evoked potentials(TcMEPs) 10 , and electromyography(EMG) 9,11,12 , have been used to reduce the risk of complications including myelopathy, C5 root palsy, and recurrent laryngeal nerve palsy (RLN) 13,14 . Significant intraoperative changes in latency and amplitude of SSEPs, and TcMEPs are generally used to alert the surgeon about impending neurological change, leading them to alter the surgical procedure in some cases 15,16 .…”

Section: Introductionmentioning

confidence: 99%

Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

Muralidharan

Loke

Habeych

et al. 2016

Journal of Clinical Neuroscience

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Abstract:Objective: The primary aim of this study is to conduct a systematic review of reports concerning patients with cervical spondylotic myelopathy to assess the value of intraoperative monitoring (IOM), such as SSEPs, TcMEPs, and EMG, in anterior cervical procedures. Methods: A search strategy was first conducted in order to collect a small database of relevant papers using key words describing both disorders and procedures of interest. The database was then shortlisted using selection criteria and data from these finalized reports was extracted to identify complications as a result of anterior cervical procedures treating cervical spondylotic myelopathy for outcome analysis on a continuous scale. Results: In the 22 studies that matched the screening criteria, only two involved the use of IOM. The 22 studies had an average of 173 patients. In studies with procedures done without IOM a mean change in JOA score of 3.94 points and a mean change in Nurick score by 1.20 points (both less severe post-op) were observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia had a mean outcome of 2.71% of cases for studies without IOM and a mean outcome of 0.91% of cases for studies with IOM. Conclusions: Based on the review of published studies sufficient evidence does not exist to negate or reinforce the use of IOM in hopes of reducing neurological complications during anterior cervical procedures. There is no standardized evaluation method to measure these complications. In addition, the modalities used for IOM have not been overwhelmingly confirmed.

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“…Relatively low sensitivity of SSEP for postoperative neurological deficit was natural in cervical spine corpectomy surgery, at which dorsal column located away from direct surgical manipulation. As 11 out of 12 cases of postoperative neurological deficit was root injury, sensitivity of SSEP was as low as 77% [21]. However, if they define postoperative neurological deficit as 'motor weakness' from spinal cord injury, the sensitivity of SSEP become 100% (1 case of permanent SSEP change resulted in quadriplegia).…”

Section: Predictability Of Mep and Ssep For Postoperative Motor Deficitmentioning

confidence: 99%

“…Nuwer et al reported through multi-center, retrospective survey that false negative SSEP was only 0.063% (34 out of 50,207 surveyed cases) after scoliosis surgery. Khan et al [26] reported that SSEP without MEP or EMG could reduce neurologic injury even during anterior cervical surgery. Their SSEP had a sensitivity of 77.1%, specificity of 100%, PPV of 100%, and NPV of 98.3%.…”

Section: Effectiveness Of Ssep In Patients Without Measurable Mepmentioning

confidence: 99%

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

Kang¹,

Gwak²,

Shin³

et al. 2016

J Spine

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Objectives: To evaluate the feasibility, sensitivity and specificity of IOM for IDEM and ED metastatic spinal tumours, and to assess usefulness of SSEP for patients in whom MEP was not measurable. Methods and materials:One hundred and one consecutive patients with IDEM and ED metastatic spinal tumours at the cord level (C1 to L1) received surgery under SSEP and/or MEP was included. Feasibility of IOM was defined to be negative in case of no measurable MEP or SSEP under general anaesthesia after confirmation of reversal of neuromuscular block. More than 50% change of MEP or SSEP amplitude and more than 10% delay of SSEP latency were evaluated as positive signs of IOM change.Results: MEP was measurable in 74 out of 101 trials, thus feasibility is 73%. Patient with normal motor power showed higher feasibility than those with motor power 3 or less. (93% vs. 39%) Among 74 patients with measurable MEP, 19 patients showed positive MEP change and 14 patients got worse of their motor power postoperatively.

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Intraoperative Somatosensory Evoked Potential Monitoring During Cervical Spine Corpectomy Surgery

Cited by 82 publications

References 35 publications

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

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