Trancranial Electric Motor Evoked Potential Detection of Hypotension Related Spinal Cord Ischemic Injury during Spine Surgery

2004 ◽  
Vol 16 (4) ◽  
pp. 349-350
Author(s):  
Fan D ◽  
Sestokas AK ◽  
Schwartz DM ◽  
Audu P
Keyword(s):  
Spinal Cord ◽  
Spine Surgery ◽  
Electric Motor ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Ischemic Injury

scholarly journals Effect of Two Anesthetic Regimes with Dexmedetomidine as Adjuvant on Transcranial Electrical Motor Evoked Potentials during Spine Surgery

2020 ◽  
Vol 07 (02) ◽  
pp. 084-090
Author(s):  
Rajeeb K. Mishra ◽  
Hemanshu Prabhakar ◽  
Indu Kapoor ◽  
Dinu S. Chandran ◽  
Arvind Chaturvedi
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Spine Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potentials ◽  
Spinal Column ◽  
Motor Evoked Potential ◽  
Standard Group ◽  
Time Points ◽  
Group D

Abstract Background Transcranial motor evoked potential (TcMEP) recording during spinal cord/spinal column surgery is a reliable and valid diagnostic adjunct to assess spinal cord integrity and is recommended if utilized for this purpose. Electrophysiologic monitoring in terms of TcMEP has been proven to be a useful tool in detecting spinal cord dysfunction at the earliest and allows corrective action to be taken before permanent neuronal dysfunction sets in. The quality of intraoperative neuromonitoring is influenced by various factors. Most anesthetics used in clinical practice suppress the evoked potentials. Thus, selecting an appropriate technique is always a challenging task. Materials and Methods Thirty ASA I and II patients scheduled for elective dorsolumbar spine surgery with TcMEP monitoring were recruited in the study. Patients were randomized into three groups: (1) Propofol (group P) 100 to 150 µg/kg/min with dexmedetomidine 0.6 µg/kg/hr and fentanyl 1 µg/kg/hr, (2) desflurane (group D) (<0.5 MAC) with dexmedetomidine 0.6 µg/kg/hr and fentanyl 1 µg/kg/hr, and (3)standard group (group S) patients received propofol 100 to 150 µg/kg/min, fentanyl 1 µg/kg/hr along with equal volume of saline (placebo). TcMEP amplitudes were recorded bilaterally from electrodes placed at least in one set of muscles with motor origin rostral and one set of muscle caudal to the spinal level of lesion at different time points. Results Three patients were excluded after allocation; 27 out of 30 patients were analyzed. The demographic and surgical characteristics of patients were comparable. The stimulation voltage needed to elicit the responses in all the three groups was comparable. No difference was observed in brachioradialis muscle amplitudes between the groups at different time points. However, in the right brachioradialis muscle, we found reduced amplitudes at baseline in group D and at 120 minutes in group P. We noticed reduced amplitudes of bilateral brachioradialis muscle in group P at 60 minutes and 90 minutes with respect to the baseline. For lower extremity, we measured amplitudes of TcMEP in tibialis anterior (TA) and did not find any difference in amplitudes between the groups at different time points. Conclusion We observed that the desflurane–dexmedetomidine combination did not hinder TcMEP as compared with both standard and propofol–dexmedetomidine groups. Thus, this combined regime could be used in surgeries requiring motor evoked potential monitoring.

Transcranial Electric Motor Evoked Potential Monitoring During Spine Surgery

Spine ◽  
2011 ◽  
Vol 36 (13) ◽  
pp. 1046-1049 ◽  
Author(s):  
Daniel M. Schwartz ◽  
Anthony K. Sestokas ◽  
John P. Dormans ◽  
Alexander R. Vaccaro ◽  
Alan S. Hilibrand ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Electric Motor ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Evoked Potential Monitoring ◽  
Potential Monitoring

scholarly journals Feasibility of adjunct facial motor evoked potential monitoring to reduce the number of false-positive results during cervical spine surgery

2020 ◽  
Vol 32 (4) ◽  
pp. 570-577
Author(s):  
Ryuta Matsuoka ◽  
Yasuhiro Takeshima ◽  
Hironobu Hayashi ◽  
Tsunenori Takatani ◽  
Fumihiko Nishimura ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
False Positive ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Unaffected Side ◽  
Cervical Spine Surgery ◽  
Supramaximal Stimulation ◽  
Evoked Potential Monitoring ◽  
Positive Results

OBJECTIVEFalse-positive intraoperative muscle motor evoked potential (mMEP) monitoring results due to systemic effects of anesthetics and physiological changes continue to be a challenging issue. Although control MEPs recorded from the unaffected side are useful for identifying a true-positive signal, there are no muscles on the upper or lower extremities to induce control MEPs in cervical spine surgery. Therefore, this study was conducted to clarify if additional MEPs derived from facial muscles can feasibly serve as controls to reduce false-positive mMEP monitoring results in cervical spine surgery.METHODSPatients who underwent cervical spine surgery at the authors’ institution who did not experience postoperative neurological deterioration were retrospectively studied. mMEPs were induced with transcranial supramaximal stimulation. Facial MEPs (fMEPs) were subsequently induced with suprathreshold stimulation. The mMEP and subsequently recorded fMEP waveforms were paired during each moment during surgery. The initial pair was regarded as the baseline. A significant decline in mMEP and fMEP amplitude was defined as > 80% and > 50% decline compared with baseline, respectively. All mMEP alarms were considered false positives. Based on 2 different alarm criteria, either mMEP alone or both mMEP and fMEP, rates of false-positive mMEP monitoring results were calculated.RESULTSTwenty-three patients were included in this study, corresponding to 102 pairs of mMEPs and fMEPs. This included 23 initial and 79 subsequent pairs. Based on the alarm criterion of mMEP alone, 17 false-positive results (21.5%) were observed. Based on the alarm criterion of both mMEP and fMEP, 5 false-positive results (6.3%) were observed, which was significantly different compared to mMEP alone (difference 15.2%; 95% CI 7.2%–23.1%; p < 0.01).CONCLUSIONSfMEPs might be used as controls to reduce false-positive mMEP monitoring results in cervical spine surgery.

Surgeon-directed transcranial motor evoked potential spinal cord monitoring in spinal deformity surgery

2021 ◽  
Vol 103-B (3) ◽  
pp. 547-552
Author(s):  
Ramanare Sibusiso Magampa ◽  
Robert Dunn
Keyword(s):  
Spinal Cord ◽  
Spinal Deformity ◽  
Early Identification ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Congenital Scoliosis ◽  
Spinal Cord Monitoring ◽  
Cord Injury ◽  
Spinal Deformity Surgery ◽  
Transcranial Motor Evoked Potential

Aims Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury which enables early intervention resulting in a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon-directed intraoperative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon-directed TcMEP is presented in terms of viability, safety, and efficacy. Methods We carried out a retrospective review of a single surgeon’s prospectively maintained database of cases in which TcMEP monitoring had been used between 2010 and 2017. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude from the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analyzed. Results Of the 299 cases reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No patient with normal traces had a postoperative clinical neurological deficit. True alerts occurred in 20 cases (6.7%). The diagnoses of the alert group included nine cases of adolescent idiopathic scoliosis (AIS) (45%) and six of congenital scoliosis (30%). The incidence of deterioration based on diagnosis was 9/153 (6%) for AIS, 6/30 (20%) for congenital scoliosis, and 2/16 (12.5%) for spinal tuberculosis. Deterioration was much more common in congenital scoliosis than in AIS (p = 0.020). Overall, 65% of alerts occurred during rod instrumentation: 15% occurred during decompression of the internal apex in vertebral column resection surgery. Four alert cases (20%) awoke with clinically detectable neurological compromise. Conclusion Surgeon-directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress, thereby enabling immediate intervention. In resource constrained environments, surgeon-directed TcMEP is a viable and effective method of intraoperative spinal cord monitoring. Level of evidence: III Cite this article: Bone Joint J 2021;103-B(3):547–552.

Sign in / Sign up

Export Citation Format

Share Document