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.

Motor Evoked Potential Monitoring during Upper Cervical Spine Surgery

Spine ◽  
1989 ◽  
Vol 14 (10) ◽  
pp. 1078-1083 ◽  
Author(s):  
HIDEKI KITAGAWA ◽  
TATSUO ITOH ◽  
HARUO TAKANO ◽  
KAZUHIKO TAKAKUWA ◽  
NAOYA YAMAMOTO ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Upper Cervical Spine ◽  
Cervical Spine Surgery ◽  
Upper Cervical ◽  
Evoked Potential Monitoring ◽  
Potential Monitoring

Evolving Compartment Syndrome Detected by Loss of Somatosensory- and Motor-evoked Potential Signals During Cervical Spine Surgery

Orthopedics ◽  
2012 ◽  
Vol 35 (9) ◽  
pp. e1453-e1456 ◽  
Author(s):  
Wesley H. Bronson ◽  
David Forsh ◽  
Sheeraz A. Qureshi ◽  
Stacie G. Deiner ◽  
Donald J. Weisz ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Compartment Syndrome ◽  
Spine Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Cervical Spine Surgery

Therapeutic Impact of Traction Release After C5 Nerve Root Motor Evoked Potential (MEP) Alerts in Cervical Spine Surgery

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
William B. Wilent ◽  
John M. Rhee ◽  
James S. Harrop ◽  
Thomas Epplin-Zapf ◽  
Mitali Bose ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Nerve Root ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Therapeutic Impact ◽  
Cervical Spine Surgery

Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients

2008 ◽  
Vol 8 (3) ◽  
pp. 215-221 ◽  
Author(s):  
Michael O. Kelleher ◽  
Gamaliel Tan ◽  
Roger Sarjeant ◽  
Michael G. Fehlings
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Neurological Deficits ◽  
Prospective Analysis ◽  
Predictive Values ◽  
Cervical Spine Surgery ◽  
Cervical Surgery ◽  
Sensitivity Specificity

Object Despite the growing use of multimodal intraoperative monitoring (IOM) in cervical spinal surgery, limited data exist regarding the sensitivity, specificity, and predictive values of such a technique in detecting new neurological deficits in this setting. The authors sought to define the incidence of significant intraoperative electrophysiological changes and new postoperative neurological deficits in a cohort of patients undergoing cervical surgery. Methods The authors conducted a prospective analysis of a consecutive series of patients who had undergone cervical surgery during a 5-year period at a university-based neurosurgical unit, in which multimodal IOM was recorded. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were determined using standard Bayesian techniques. The study population included 1055 patients (614 male and 441 female) with a mean age of 55 years. Results The IOM modalities performed included somatosensory evoked potential (SSEP) recording in 1055 patients, motor evoked potential (MEP) recording in 26, and electromyography (EMG) in 427. Twenty-six patients (2.5%) had significant SSEP changes. Electromyographic activity was transient in 212 patients (49.6%), and 115 patients (26.9%) had sustained burst or train activity. New postoperative neurological deficits occurred in 34 patients (3.2%): 6 had combined sensory and motor deficits, 7 had new sensory deficits, 9 had increased motor weakness, and 12 had new root deficits. Of these 34 patients, 12 had spinal tumors, of which 7 were intramedullary. Overall, of the 34 new postoperative deficits, 21 completely resolved, 9 partially resolved, and 4 had no improvement. The deficits that completely resolved did so on average 3.3 months after surgery. Patients with deficits that did not fully resolve (partial or no improvement) were followed up for an average of 1.8 years after surgery. Somatosensory evoked potentials had a sensitivity of 52%, a specificity of 100%, a PPV of 100%, and an NPV of 97%. Motor evoked potential sensitivity was 100%, specificity 96%, PPV 96%, and NPV 100%. Electromyography had a sensitivity of 46%, specificity of 73%, PPV of 3%, and an NPV of 97%. Conclusions Combined neurophysiological IOM with EMG and SSEP recording and the selective use of MEPs is helpful for predicting and possibly preventing neurological injury during cervical spine surgery.

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