Monitoring of Motor and Somatosensory Evoked Potentials During Spine Surgery: Intraoperative Changes and Postoperative Outcomes

Chang, Shin Hye; Park, Yoon Ghil; Kim, Dae Hyun; Yoon, Seo Yeon

doi:10.5535/arm.2016.40.3.470

Cited by 31 publications

(19 citation statements)

References 33 publications

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“…For postoperative neurologic deterioration, the alert criteria for intraoperative MEP changes vary from 50% to 75% in amplitude reduction [ 4 ]. Some studies included amplitude criterion in addition to the latency criterion for SEP monitoring [ 4 19 20 ]. The specific alarm criteria in our spine hospital are a more than 50% reduction in MEP amplitude, and a more than 10% of N20 or P37 latency prolongation for SEPs.…”

Section: Discussionmentioning

confidence: 99%

“…This study reconfirms the conclusion of previous studies that the highest reliability can be achieved by performing both MEPs and SEPs simultaneously. In our previous study, we reported only SEP changes predicted persistent motor deterioration in spinal cord tumor surgery, and a combined MEP/SEP monitoring showed high sensitivity and specificity in spinal deformity surgery [ 20 ]. To follow up on our previous study, we now make findings on the different sensitivities and specificities of MEPs and SEPs observed for each type of spinal cord tumor by anatomical and pathological type.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types

Park

et al. 2017

Ann Rehabil Med

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ObjectiveTo identify which combination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is most reliable for postoperative motor deterioration during spinal cord tumor surgery, according to anatomical and pathologic type.MethodsMEPs and SEPs were monitored in patients who underwent spinal cord tumor surgery between November 2012 and August 2016. Muscle strength was examined in all patients before surgery, within 48 hours postoperatively and 4 weeks later. We analyzed sensitivity, specificity, positive and negative predictive values of each significant change in SEPs and MEPs.ResultsThe overall sensitivity and specificity of SEPs or MEPs were 100% and 61.3%, respectively. The intraoperative MEP monitoring alone showed both higher sensitivity (67.9%) and specificity (83.2%) than SEP monitoring alone for postoperative motor deterioration. Two patients with persistent motor deterioration had significant changes only in SEPs. There are no significant differences in reliabilities between anatomical types, except with hemangioma, where SEPs were more specific than MEPs for postoperative motor deterioration. Both overall positive and negative predictive values of MEPs were higher than the predictive values of SEPs. However, the positive predictive value was higher by the dual monitoring of MEPs and SEPs, compared to MEPs alone.ConclusionFor spinal cord tumor surgery, combined MEP and SEP monitoring showed the highest sensitivity for the postoperative motor deterioration. Although MEPs are more specific than SEPs in most types of spinal cord tumor surgery, SEPs should still be monitored, especially in hemangioma surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types

Park

et al. 2017

Ann Rehabil Med

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“…However, SEPs reflect only the functional integrity of the spinal sensory pathway, and there have been reports of postoperative paralysis despite the appearance of intact SEPs ( 7 ). In addition, SEP recording requires a signal averaging process, which results in a time delay while the neurophysiological physician communicates with the surgeon ( 8 ). This lack of real-time feedback prior to intervention may lead to an irreversible spinal cord injury ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Changes in transcranial electrical motor‑evoked potentials during the early and reversible stage of permanent spinal cord ischemia predict spinal cord injury in a rabbit animal model

et al. 2017

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The present study examined changes in the transcranial electrical motor-evoked potentials (TceMEP) waveform to predict neurological deficits and histopathological changes during the early and reversible stage of different levels of permanent spinal cord ischemic injury in a rabbit animal model. A total of 24 New Zealand rabbits were randomly divided into four groups of 6 rabbits each. Group 1 underwent a ligation of the lumbar artery at three levels (L1-L3), group 2 underwent a ligation of the lumbar artery at four levels (L1-L4) and group 3 underwent a ligation of the lumbar artery at five levels (L1-L5). The sham group contained 6 rabbits and did not receive ligation. TceMEP was recorded within 5 min of ligation and, 2 days later, motor function was assessed and the spinal cords were removed for histological examination. Following spinal cord injury, the relationship between variations in the TceMEP waveform and motor function and pathological damage was analyzed. It was observed that the amplitude of TceMEP began to decrease within 1 min of lumbar artery ligation and that the amplitude stabilized within 5 min. These amplitude changes that occurred within 5 min of different levels of permanent spinal cord ischemic injury were positively related to changes in motor function following recovery from anesthesia and 2 days after ligation. The Pearson correlation coefficient was 0.980 and 0.923 for these two time points, respectively (P<0.001). In addition, the amplitude changes were positively related to pathological damage, with a Pearson correlation coefficient of 0.945 (P<0.001). The results of the present study suggested that amplitude changes in TceMEP are particularly sensitive to ischemia. Ischemia may be detected within 1 min and the amplitude changes begin to stabilize within 5 min following ligation of the lumbar artery. The use of intraoperative monitoring of TceMEP allows for the detection of spinal cord ischemic injury with no time delay, which may allow for protective measures to be taken to prevent the occurrence of irreversible spinal cord injury.

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“…3 However, many studies have suggested that SEPs do not reflect the specificity of motor pathways, as there are several so-called falsenegative results, i.e., emergence of postoperative motor deficits despite unchanged intraoperative SEPs. 4,5 In addition, SEP deterioration can occur in numerous situations such as dorsal column injury, stimulus failure, and distal conduction block, which may result in amplitude reduction below an arbitrary 50% and can falsely imply motor injury. 6 To date, muscle motor evoked potentials (MEPs) are also monitored.…”

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confidence: 99%

Increased Intraoperative Motor Evoked Potentials and Motor Recovery after Spinal Cord Tumor Removal

Pyo¹,

Park²,

Ko³

et al. 2018

jouranlofkoreanassociationofemgelectrodiagnosticmedicine

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Objective: To evaluate whether the increase of the amplitude of motor evoked potentials (MEPs) during surgery can imply favorable prognosis postoperatively in spinal cord tumor surgery. Method: MEPs were monitored in patients who underwent spinal cord tumor surgery between March 2016 and March 2018. Amplitude changes at the end of monitoring compared to the baselines in limb muscle were analyzed. Minimum and maximum changes were set to MEP min (%) and MEP max (%). Strengths of bilateral 10 key muscles which were documented a day before (Motor pre), 48 h (Motor 48h) and 4 weeks (Motor 4wk) after the surgery were reviewed. Results: Difference of Motor 48h from Motor pre (Motor 48h-pre) and Motor 4wk from Motor pre (Motor 4wk-pre) positively correlated with MEP min , suggesting that smaller the difference of MEPs amplitude, less recovery of muscle strength. There was a negative correlation between the amount of bleeding and MEP min , indicating that the greater the amount of bleeding, the smaller the MEP min , implying that MEPs amplitude is less likely to improve when the amount of bleeding is large. It also showed significant difference between patients with improved or no change of motor status and patients with motor deterioration after surgery according to anatomical tumor types. Conclusion: Improve of muscle strength was less when the increase of MEPs amplitude was small, and improvement of MEPs amplitude was less when the amount of bleeding was large. Correlation between changes of status of muscle strength after surgery and tumor types was observed. With amplitude increase in MEPs monitoring, restoration of muscle strength can be expected.

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Monitoring of Motor and Somatosensory Evoked Potentials During Spine Surgery: Intraoperative Changes and Postoperative Outcomes

Cited by 31 publications

References 33 publications

Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types

Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types

Changes in transcranial electrical motor‑evoked potentials during the early and reversible stage of permanent spinal cord ischemia predict spinal cord injury in a rabbit animal model

Increased Intraoperative Motor Evoked Potentials and Motor Recovery after Spinal Cord Tumor Removal

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