Ann Rehabil Med.  2016 Jun;40(3):470-480. 10.5535/arm.2016.40.3.470.

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

• Chang SH
• Park YG
• Kim DH
• Yoon SY

• KMID: 2327609
• DOI: http://doi.org/10.5535/arm.2016.40.3.470

Abstract

OBJECTIVE
To evaluate whether the combination of muscle motor evoked potentials (mMEPs) and somatosensory evoked potentials (SEPs) measured during spinal surgery can predict immediate and permanent postoperative motor deficits.
METHODS
mMEP and SEP was monitored in patients undergoing spinal surgery between November 2012 and July 2014. mMEPs were elicited by a train of transcranial electrical stimulation over the motor cortex and recorded from the upper/lower limbs. SEPs were recorded by stimulating the tibial and median nerves.
RESULTS
Combined mMEP/SEP recording was successfully achieved in 190 operations. In 117 of these, mMEPs and SEPs were stable and 73 showed significant changes. In 20 cases, motor deficits in the first 48 postoperative hours were observed and 6 patients manifested permanent neurological deficits. The two potentials were monitored in a number of spinal surgeries. For surgery on spinal deformities, the sensitivity and specificity of combined mMEP/SEP monitoring were 100% and 92.4%, respectively. In the case of spinal cord tumor surgeries, sensitivity was only 50% but SEP changes were observed preceding permanent motor deficits in some cases.
CONCLUSION
Intraoperative monitoring is a useful tool in spinal surgery. For spinal deformity surgery, combined mMEP/SEP monitoring showed high sensitivity and specificity; in spinal tumor surgery, only SEP changes predicted permanent motor deficits. Therefore, mMEP, SEP, and joint monitoring may all be appropriate and beneficial for the intraoperative monitoring of spinal surgery.

Keyword

Motor evoked potentials; Somatosensory evoked potentials; Intraoperative neurophysiological monitoring; Spine

MeSH Terms

Congenital Abnormalities
Evoked Potentials, Motor
Evoked Potentials, Somatosensory*
Extremities
Humans
Intraoperative Neurophysiological Monitoring
Joints
Median Nerve
Monitoring, Intraoperative
Motor Cortex
Sensitivity and Specificity
Spinal Cord Neoplasms
Spine*
Transcranial Direct Current Stimulation

Figure

• 

  Fig. 1 Intraoperative monitoring and clinical outcome in spinal operations. MEP, motor evoked potential; SEP, somatosensory evoked potential.

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