scholarly journals Transcranial Electrical Motor Evoked Potential in Predicting Positive Functional Outcome of Patients after Decompressive Spine Surgery: Review on Challenges and Recommendations towards Objective Interpretation

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Mohd Redzuan Jamaludin ◽  
Khin Wee Lai ◽  
Joon Huang Chuah ◽  
Muhammad Afiq Zaki ◽  
Yan Chai Hum ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Functional Outcome ◽  
Evoked Potential ◽  
Motor Nerve ◽  
Motor Evoked Potential ◽  
Nerve Roots ◽  
Motor Pathway ◽  
Positive Functional ◽  
Prognostic Tool ◽  
Objective Interpretation

Spine surgeries impose risk to the spine’s surrounding anatomical and physiological structures especially the spinal cord and the nerve roots. Intraoperative neuromonitoring (IONM) is a technology developed to monitor the integrity of the spinal cord and the nerve roots via the surgery. Transcranial motor evoked potential (TcMEP) (one of the IONM modalities) is adopted to monitor the integrity of the motor pathway of the spinal cord and the motor nerve roots. Recent research suggested that the IONM is conducive as a prognostic tool towards the patient’s functional outcome. This paper summarizes the researches of IONM being adopted as a prognostic tool. In addition, this paper highlights the problems associated with the signal parameters as the improvement criteria in the previous researches. Lastly, we review the challenges of TcMEP to achieve a prognostic tool focusing on the factors that could interfere with the generation of a stable TcMEP response. The final section will discuss recommendations for IONM technology to achieve an objective prognostic tool.

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.

scholarly journals Correlation of motor-evoked potential response to ischemic spinal cord damage

1992 ◽  
Vol 104 (2) ◽  
pp. 262-272 ◽  
Author(s):  
David G. Reuter ◽  
Willis A. Tacker ◽  
Stephen F. Badylak ◽  
William D. Voorhees ◽  
Peter E. Konrad
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Potential Response ◽  
Spinal Cord Damage

scholarly journals Motor-Evoked Potential Confirmation of Functional Improvement by Transplanted Bone Marrow Mesenchymal Stem Cell in the Ischemic Rat Brain

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Dong-Kyu Jang ◽  
Sang-In Park ◽  
Young-Min Han ◽  
Kyung-Sool Jang ◽  
Moon-Seo Park ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Rat Brain ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Functional Improvement ◽  
Control Group ◽  
Motor Pathway ◽  
Bipolar Stimulation ◽  
Marrow Mesenchymal Stem Cells ◽  
Monopolar Stimulation

This study investigated the effect of bone marrow mesenchymal stem cells (BMSCs) on the motor pathway in the transient ischemic rat brain that were transplanted through the carotid artery, measuring motor-evoked potential (MEP) in the four limbs muscle and the atlantooccipital membrane, which was elicited after monopolar and bipolar transcortical stimulation. After monopolar stimulation, the latency of MEP was significantly prolonged, and the amplitude was less reduced in the BMSC group in comparison with the control group (). MEPs induced by bipolar stimulation in the left forelimb could be measured in 40% of the BMSC group and the I wave that was not detected in the control group was also detected in 40% of the BMSC group. Our preliminary results imply that BMSCs transplanted to the ischemic rat brain mediate effects on the functional recovery of the cerebral motor cortex and the motor pathway.

The MEP in clinical neurodiagnosis

2012 ◽  
Author(s):  
Friedhelm Sandbrink
Keyword(s):  
Motor Neuron ◽  
Neurological Disorders ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Motor Neuron Diseases ◽  
Motor Pathway ◽  
Pathway Function ◽  
Transcranial Electric Stimulation ◽  
Lumbar Spinal ◽  
Stimulation Of

This article gives information on the clinical application of motor-evoked potential (MEP). Transcranial stimulation of the cerebral cortex to elicit MEPs is a noninvasive method for assessing the integrity of the central motor pathway function. Transcranial magnetic stimulation (TMS) is used in diagnosing and monitoring neurological disorders. This article highlights the neurophysiological differences between TMS and transcranial electric stimulation. All the different MEP parameters that can be measured by TMS, the latency of the MEP is generally regarded as the most reliable and useful. TMS studies have been described in many neurological disorders. The sensitivity of TMS in detecting subclinical upper motor neuron lesion varies in different disorders, depending on number of muscles and different parameters used. This article talks about the application of MEP in pathophysiology, multiple sclerosis, motor neuron diseases, meyloptahy, cerebral infarction, movement disorders, epilepsy, Lumbar spinal stenosis and radiculopathies, peripheral nerve disorders etc.

Sign in / Sign up

Export Citation Format

Share Document