Surgical Causes of Significant Intraoperative Neuromonitoring Signal Changes in Three-Column Spinal Surgery

Abstract Background: The use of intraoperative neuromonitoring is a well-established method of detecting neurologic injuries during spine surgery. Anaesthesia, especially inhalational agents, influence motor evoked potential (MEP) monitoring. The aim of our study was to compare the effect of balanced anaesthesia (BA) (intravenous plus inhalational anaesthesia) and total intravenous anaesthesia (TIVA) on the incidence of intraoperative neuromonitoring changes, interventions performed and neurological outcomes of patients following high-risk spinal surgery. Methods: After Research and Ethics Board approval, a retrospective review of 155 patients who underwent spinal surgery with MEP was performed. Data were collected on changes in MEP and/or somatosensory evoked potential, interventions performed and neurological outcomes. Patients were divided into BA and TIVA groups and data were analysed. Results: A total of 152 patients were eligible for the study (mean age 54 ± 17, male: female 45:55). A BA technique was used in 62% and TIVA in 38%. Desflurane (<0.5 minimum alveolar concentration [MAC]) was used in 85% BA cases. Intraoperative neuromonitoring changes occurred in 11.8% (18/152) of cases. There was no statistical difference in the incidence of monitoring changes between BA (78%) and TIVA (22%) groups (P = 0.197). Anaesthetic or surgical interventions were performed in 12 patients, with a resolution of changes in 50% (P = 0.455). All 5 patients with persistent MEP changes had worsening of existing neurological deficits postoperatively; 8 had transient MEP changes, and 2 experienced worsening of existing neurological deficits. Conclusions: We found that intraoperative neurophysiological monitoring can be performed with both BA (MAC <0.5) and TIVA in high-risk spinal surgery with no statistical difference in the incidence of intraoperative monitoring changes.

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136 Intraoperative Neuromonitoring in Spinal Surgery: A Systematic Review and Meta-Analyses

British Journal of Surgery ◽

10.1093/bjs/znab134.195 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

W W Ang ◽

S Boutong ◽

N Shetty

Keyword(s):

Patient Outcomes ◽

Spinal Surgery ◽

Cost Effective ◽

Cost Utility ◽

Intraoperative Neuromonitoring ◽

Highly Sensitive ◽

Significant Difference ◽

Meta Analyses ◽

Neurological Injuries

Abstract Introduction Intraoperative neuromonitoring (IONM) is widely used in spinal surgery as it has been shown to be highly sensitive and specific for detecting neurological injuries, although recent evidence has been conflicting in its cost-utility. The authors aim to determine whether the use of IONM during spinal surgeries significantly improves patient outcomes in terms of neurological events, and whether IONM is cost-effective. Method Literature search of studies looking at use of IONM for spinal surgeries from 2009 to 2020 was performed across several databases, following PRISMA guidelines. Quality of articles was assessed using MINORS criteria. Results The random effects model was used to evaluate the 5 studies comparing neurological events with and without IONM use. There was a higher incidence of neurological events without IONM, at 44 compared to 11 with IONM. However, pooled odds ratio was 0.56 (p = 0.11), indicating no significant difference. IONM was also found to be associated with longer operative times and costs, which is not cost-effective based on NICE recommendations. Conclusions - This study corroborate previous studies; there is no significant difference in patient outcome of neurological events with the use of IONM. There is, however, a higher incidence of neurological events without IONM.

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Severe hypotension with loss of motor evoked potentials during cervical surgery prompting immediate cardiovascular resuscitation

Surgical Neurology International ◽

10.25259/sni_336_2021 ◽

2021 ◽

Vol 12 ◽

pp. 281

Author(s):

Daniel C. Kim ◽

Ethan J. Boyd ◽

Thomas A. Boyd ◽

Hannah E. Granger ◽

Richard P. Menger

Keyword(s):

Spinal Surgery ◽

Motor Evoked Potentials ◽

High Sensitivity ◽

Intraoperative Neuromonitoring ◽

Drop Out ◽

Postoperative Function ◽

Severe Hypotension ◽

Cervical Surgery ◽

Spinal Deformity Surgery ◽

Neurological Insult

Background: Intraoperative neuromonitoring (IONM) is a well-established adjunct to spinal surgery to ensure safety of the neural elements.IONM has extremely high sensitivity and specificity for impending neurologic damage. In very rare instances, hypoperfusion of the cord may lead to a loss of IONM modalities that may be reversed if blood pressure issues responsible for the drop out of potentials are immediately addressed. Case Description: The authors describe a case in which IONM documented hypoperfusion of the cord intraoperatively due to hypotension. Recognition of this problem and reversal of the hypotension resulted in normalization of postoperative function. Conclusion: The use of IONM allowed for quick recognition of an impending neurological insult during spinal deformity surgery. Prompt response to signaling changes allowed for the correction of hypotension and favorable neurologic outcome.

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P11.13 Prevention of brachial plexus injury due to positioning of patient in spinal surgery. Value of multimodal intraoperative neuromonitoring (IONM)

Clinical Neurophysiology ◽

10.1016/s1388-2457(11)60401-x ◽

2011 ◽

Vol 122 ◽

pp. S113 ◽

Cited By ~ 1

Author(s):

E. Araus-Galdós ◽

P. Delgado ◽

C. Villalain ◽

V. Martin-Velasco ◽

J.M. Castilla ◽

...

Keyword(s):

Brachial Plexus ◽

Spinal Surgery ◽

Brachial Plexus Injury ◽

Intraoperative Neuromonitoring

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Cost-utility Analysis-Comparison between with and without using Intraoperative Neuromonitoring in Spinal Surgery for Adolescent Idiopathic Scoliosis Patients

Journal of Surgery and Research ◽

10.26502/jsr.10020069 ◽

2020 ◽

Vol 03 (03) ◽

Author(s):

Chaiwat Lorphongphaiboon ◽

Anand Sachamuneewongse ◽

Thanita Panya-amornwat ◽

Athikom Methathien ◽

Yongyot Laungwitchajareon ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Surgery ◽

Cost Utility ◽

Intraoperative Neuromonitoring ◽

Cost Utility Analysis ◽

Utility Analysis

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Direct Stimulation of Neural Placode and Nerve Roots in Open Myelomeningocele: The Efficacy of Neural Tube Reconstruction

Pediatric Neurosurgery ◽

10.1159/000512369 ◽

2020 ◽

Vol 55 (6) ◽

pp. 336-343

Author(s):

Mehmet Can Ezgu ◽

Alparslan Kırık ◽

Soner Yasar ◽

Yusuf Izci

Keyword(s):

Nerve Root ◽

Spinal Surgery ◽

Lower Extremities ◽

Intraoperative Neuromonitoring ◽

Direct Stimulation ◽

Nerve Roots ◽

Electrophysiological Studies ◽

Free Running ◽

Patient Responses ◽

Stimulation Of

Introduction: Intraoperative electrophysiological studies are increasingly used in spinal surgery. However, its use in myelomeningocele (MMC) surgery is still not widespread. The aim of this study was to present our experience in neural placode (NP) and nerve root stimulations in newborns with open MMC. Methods: Eight newborns underwent surgical treatment for thoracolumbar and lumbosacral MMCs. Intraoperative neuromonitoring including free-running electromyography and stimulation of NP, nerve roots, and spinal cord were performed in all cases. Stimulation sites and intensities and distal response’s amplitudes and latencies were recorded. Results: Five patients had thoracolumbar and 3 patients had lumbosacral MMC. Two patients had no movements at the lower extremities while the other had some movements. No response on the lower extremities was obtained in only 1 patient. Responses from the nerve root stimulations were more robust and significant than the placode stimulations. Conclusions: It is clear that the NP and nerve roots originating from the placode are mostly functional and should be preserved during the surgery. Intraoperative neuromonitoring and direct stimulation should be performed during the MMC repair in order to obtain a better neurological outcome.

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