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Postoperative Changes and Outcomes in Intaoperative Neurophysiological Monitoring in Scoliosis Surgery
Keywords:
Scoliosis, Transcranial electric motor evoked potentials, Somatosensory evoked potentials.Abstract
Objective: To evaluate the advantages of combined motor and sensory evoked potential monitoring during scoliosis surgery.
Methods: We performed and analyzed the records of 107 (83 Female (77.5%) and 24 male (22.4%) Scoliosis surgery patients with Transcranial electric motor evoked potential and somatosensory evoked potential performed at spine surgery center, Ghurki Trust Teaching Hospital Lahore. Mean age was 14.7 years. Patients who showed significant up to (45%) in baseline signals loss unilateral or bilateral limbs during surgical intervention in scoliosis surgery under total intravenous anesthesia is included.
Results: Motor Evoked Potentials and Somato-Sensory Evoked Potenials of 107 patients in intraoperative neurophysiological monitoring were performed jointly. 21 (19.6%) patients have mark or significant changes in baseline signals on transcranial motor evoked potentials. Seventeen 17 (15.8%) Patients have complete return of baseline signals after surgical intervention by surgeon, whereas 04 (3.73%) patients have return of motor signals after 14 hours of surgery. Transcranial electric motor evoked potentials monitoring was 100% specific and 100% sensitive, however Somatosensory evoked potential was 100% specific and 84% sensitive.
Conclusions: MEPs and SSEPs, in combination gives accurate and correct information of any surgical insult and neurology in real time during Scoliosis surgery.
References
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6. Pastorelli F, Di Silvestre M, Plasmati R, Michelucci R, Greggi T, Morigi A, et al. The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011 May;20 Suppl 1:S105-14. PubMed PMID: 21416379. Pubmed Central PMCID: PMC3087032. Epub 2011/03/19. eng.
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13. Lee CH, Kim HW, Kim HR, Lee CY, Kim JH, Sala F. Can triggered electromyography thresholds assure accurate pedicle screw placements? A systematic review and meta-analysis of diagnostic test accuracy. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology. 2015 Oct;126(10):2019-25. PubMed PMID: 25660410. Epub 2015/02/11. eng.
14. Holdefer RN, Heffez DS, Cohen BA. Utility of evoked EMG monitoring to improve bone screw placements in the cervical spine. Journal of spinal disorders & techniques. 2013 Jul;26(5):E163-9. PubMed PMID: 23429315. Epub 2013/02/23. eng.
15. Schwartz DM, Sestokas AK, Dormans JP, Vaccaro AR, Hilibrand AS, Flynn JM, et al. Transcranial electric motor evoked potential monitoring during spine surgery: is it safe? Spine. 2011 Jun;36(13):1046-9. PubMed PMID: 21217447. Epub 2011/01/11. eng.
16. Wilson B, Curtis E, Hirshman B, Oygar A, Chen K, Gabel BC, et al. Lateral mass screw stimulation thresholds in posterior cervical instrumentation surgery: a predictor of medial deviation. Journal of neurosurgery Spine. 2017 Mar;26(3):346-52. PubMed PMID: 27935447. Pubmed Central PMCID: PMC5485827. Epub 2016/12/10. eng.
17. De Blas G, Barrios C, Regidor I, Montes E, Burgos J, Piza-Vallespir G, et al. Safe pedicle screw placement in thoracic scoliotic curves using t-EMG: stimulation threshold variability at concavity and convexity in apex segments. Spine. 2012 Mar 15;37(6):E387-95. PubMed PMID: 22024903. Epub 2011/10/26. eng.
18. Sloan TB, Toleikis JR, Toleikis SC, Koht A. Intraoperative neurophysiological monitoring during spine surgery with total intravenous anesthesia or balanced anesthesia with 3% desflurane. Journal of clinical monitoring and computing. 2015 Feb;29(1):77-85. PubMed PMID: 24643708. Epub 2014/03/20. eng.
19. Malcharek MJ, Loeffler S, Schiefer D, Manceur MA, Sablotzki A, Gille J, et al. Transcranial motor evoked potentials during anesthesia with desflurane versus propofol--A prospective randomized trial. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology. 2015 Sep;126(9):1825-32. PubMed PMID: 25541524. Epub 2014/12/30. eng.
20. Jeswani S, Drazin D, Hsieh JC, Shweikeh F, Friedman E, Pashman R, et al. Instrumenting the small thoracic pedicle: the role of intraoperative computed tomography image-guided surgery. Neurosurgical focus. 2014 Mar;36(3):E6. PubMed PMID: 24580007. Epub 2014/03/04. eng.
21. Lall RR, Lall RR, Hauptman JS, Munoz C, Cybulski GR, Koski T, et al. Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist. Neurosurgical focus. 2012 Nov;33(5):E10. PubMed PMID: 23116090. Epub 2012/11/03. eng.
22. Thirumala PD, Crammond DJ, Loke YK, Cheng HL, Huang J, Balzer JR. Diagnostic accuracy of motor evoked potentials to detect neurological deficit during idiopathic scoliosis correction: a systematic review. Journal of neurosurgery Spine. 2017 Mar;26(3):374-83. PubMed PMID: 27935448. Epub 2016/12/10.
2. Plata Bello J, Perez-Lorensu PJ, Roldan-Delgado H, Brage L, Rocha V, Hernandez-Hernandez V, et al. Role of multimodal intraoperative neurophysiological monitoring during positioning of patient prior to cervical spine surgery. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology. 2015 Jun;126(6):1264-70. PubMed PMID: 25449556. Epub 2014/12/03. eng.
3. Tobert DG, Glotzbecker MP, Hresko MT, Karlin LI, Proctor MR, Emans JB, et al. Efficacy of Intraoperative Neurophysiologic Monitoring for Pediatric Cervical Spine Surgery. Spine. 2017 Jul 1;42(13):974-8. PubMed PMID: 27792108. Epub 2016/10/30. eng.
4. Neira VM, Ghaffari K, Bulusu S, Moroz PJ, Jarvis JG, Barrowman N, et al. Diagnostic Accuracy of Neuromonitoring for Identification of New Neurologic Deficits in Pediatric Spinal Fusion Surgery. Anesthesia and analgesia. 2016 Dec;123(6):1556-66. PubMed PMID: 27861447. Epub 2016/11/20. eng.
5. Thirumala PD, Bodily L, Tint D, Ward WT, Deeney VF, Crammond DJ, et al. Somatosensory-evoked potential monitoring during instrumented scoliosis corrective procedures: validity revisited. The spine journal: official journal of the North American Spine Society. 2014 Aug 01;14(8):1572-80. PubMed PMID: 24361128. Epub 2013/12/24. eng.
6. Pastorelli F, Di Silvestre M, Plasmati R, Michelucci R, Greggi T, Morigi A, et al. The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011 May;20 Suppl 1:S105-14. PubMed PMID: 21416379. Pubmed Central PMCID: PMC3087032. Epub 2011/03/19. eng.
7. Scibilia A, Terranova C, Rizzo V, Raffa G, Morelli A, Esposito F, et al. Intraoperative neurophysiological mapping and monitoring in spinal tumor surgery: sirens or indispensable tools? Neurosurgical focus. 2016 Aug;41(2):E18. PubMed PMID: 27476842. Epub 2016/08/02. eng.
8. Siller S, Szelenyi A, Herlitz L, Tonn JC, Zausinger S. Spinal cord hemangioblastomas: significance of intraoperative neurophysiological monitoring for resection and long-term outcome. Journal of neurosurgery Spine. 2017 Apr;26(4):483-93. PubMed PMID: 27982764. Epub 2016/12/17. eng.
9. Keller CM, McNeill D, Piper JT, Sinha SR. Use of Subtemporal Electrode Chains and Their Contribution to Presurgical Evaluation. The Neurodiagnostic journal. 2018;58(3):164-73. PubMed PMID: 30257166. Epub 2018/09/27. eng.
10. Xu R, Ritzl EK, Sait M, Sciubba DM, Wolinsky JP, Witham TF, et al. A role for motor and somatosensory evoked potentials during anterior cervical discectomy and fusion for patients without myelopathy: Analysis of 57 consecutive cases. Surg Neurol Int. 2011;2:133. PubMed PMID: 22059128. Pubmed Central PMCID: PMC3205491. Epub 2011/11/08. eng.
11. Mikula AL, Williams SK, Anderson PA. The use of intraoperative triggered electromyography to detect misplaced pedicle screws: a systematic review and meta-analysis. Journal of neurosurgery Spine. 2016 Apr;24(4):624-38. PubMed PMID: 26654343. Epub 2015/12/15. eng.
12. Calancie B, Donohue ML, Moquin RR. Harris CB, Canute GW, Singla A, Wilcoxen KG. et al. Neuromonitoring with pulse-train stimulation for implantation of thoracic pedicle screws: a blinded and randomized clinical study. Part 2. The role of feedback. Journal of neurosurgery Spine. 2014 Jun;20(6):692-704. PubMed PMID: 24684176. Epub 2014/04/02. eng.
13. Lee CH, Kim HW, Kim HR, Lee CY, Kim JH, Sala F. Can triggered electromyography thresholds assure accurate pedicle screw placements? A systematic review and meta-analysis of diagnostic test accuracy. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology. 2015 Oct;126(10):2019-25. PubMed PMID: 25660410. Epub 2015/02/11. eng.
14. Holdefer RN, Heffez DS, Cohen BA. Utility of evoked EMG monitoring to improve bone screw placements in the cervical spine. Journal of spinal disorders & techniques. 2013 Jul;26(5):E163-9. PubMed PMID: 23429315. Epub 2013/02/23. eng.
15. Schwartz DM, Sestokas AK, Dormans JP, Vaccaro AR, Hilibrand AS, Flynn JM, et al. Transcranial electric motor evoked potential monitoring during spine surgery: is it safe? Spine. 2011 Jun;36(13):1046-9. PubMed PMID: 21217447. Epub 2011/01/11. eng.
16. Wilson B, Curtis E, Hirshman B, Oygar A, Chen K, Gabel BC, et al. Lateral mass screw stimulation thresholds in posterior cervical instrumentation surgery: a predictor of medial deviation. Journal of neurosurgery Spine. 2017 Mar;26(3):346-52. PubMed PMID: 27935447. Pubmed Central PMCID: PMC5485827. Epub 2016/12/10. eng.
17. De Blas G, Barrios C, Regidor I, Montes E, Burgos J, Piza-Vallespir G, et al. Safe pedicle screw placement in thoracic scoliotic curves using t-EMG: stimulation threshold variability at concavity and convexity in apex segments. Spine. 2012 Mar 15;37(6):E387-95. PubMed PMID: 22024903. Epub 2011/10/26. eng.
18. Sloan TB, Toleikis JR, Toleikis SC, Koht A. Intraoperative neurophysiological monitoring during spine surgery with total intravenous anesthesia or balanced anesthesia with 3% desflurane. Journal of clinical monitoring and computing. 2015 Feb;29(1):77-85. PubMed PMID: 24643708. Epub 2014/03/20. eng.
19. Malcharek MJ, Loeffler S, Schiefer D, Manceur MA, Sablotzki A, Gille J, et al. Transcranial motor evoked potentials during anesthesia with desflurane versus propofol--A prospective randomized trial. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology. 2015 Sep;126(9):1825-32. PubMed PMID: 25541524. Epub 2014/12/30. eng.
20. Jeswani S, Drazin D, Hsieh JC, Shweikeh F, Friedman E, Pashman R, et al. Instrumenting the small thoracic pedicle: the role of intraoperative computed tomography image-guided surgery. Neurosurgical focus. 2014 Mar;36(3):E6. PubMed PMID: 24580007. Epub 2014/03/04. eng.
21. Lall RR, Lall RR, Hauptman JS, Munoz C, Cybulski GR, Koski T, et al. Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist. Neurosurgical focus. 2012 Nov;33(5):E10. PubMed PMID: 23116090. Epub 2012/11/03. eng.
22. Thirumala PD, Crammond DJ, Loke YK, Cheng HL, Huang J, Balzer JR. Diagnostic accuracy of motor evoked potentials to detect neurological deficit during idiopathic scoliosis correction: a systematic review. Journal of neurosurgery Spine. 2017 Mar;26(3):374-83. PubMed PMID: 27935448. Epub 2016/12/10.
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2019-01-02
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Postoperative Changes and Outcomes in Intaoperative Neurophysiological Monitoring in Scoliosis Surgery. (2019). Journal of Pakistan Orthopaedic Association, 30(03), 117-122. http://jpoa.org.pk/index.php/upload/article/view/220
