Analysis of Intraoperative Neurological Complications in High-Risk Spinal Surgery with the Use of Motor Evoked Potential Monitoring (고위험 척추 수술에서 운동유발 전위 검사의 이용과 이를 통한 수술 중 신경학적 이상 발생의 원인에 대한 분석)

Jin-Hyeok Kim (김진혁); 임동주; Sung-Soo Kim (김성수); 석세일; 김민규

Analysis of Intraoperative Neurological Complications in High-Risk Spinal Surgery with the Use of Motor Evoked Potential Monitoring

Journal of Korean Society of Spine Surgery
Abbr : J Kor Spine Sur
2011, 18(3), pp.153-162
Publisher : Korean Society Of Spine Surgery
Research Area : Medicine and Pharmacy > Orthopedic Surgery

Jin-Hyeok Kim ¹, 임동주 ¹, Sung-Soo Kim ¹, 석세일 ¹, 김민규 ¹

¹인제대학교

Accredited

ABSTRACT

Study Design: This is retrospective study. Objectives: To evaluate the risk of operative techniques using Motor Evoked Potential (MEP) in high-risk spinal surgery. Summary of Literature Review: There are few studies regarding the evaluation of operative techniques by MEP. Materials and Methods: We studied 33 cases that had MEP during surgery from July 2007 to March 2009. Diagnoses included posttraumatic kyphosis (PTK) in eight cases, congenital deformity in eight cases, degenerative lumbar deformity in eight cases, ankylosing spondylitis (AS) in three cases, spinal tumor in three cases, adjacent segmental disease in two cases, and post-surgical kyphosis in one case. Posterior vertebral column resection (PVCR) and pedicle subtraction osteotomy (PSO) were performed in 27 cases (81.8%) and, in the others, posterior decompression with discectomy was performed. We analyzed the risk of operative techniques and evaluated the MEP. Results: MEP showed abnormal signal change in five cases (PVCR: one case, compression and distraction: four cases). The AS case did not demonstrate neurological change after surgery. Though the PTK on T12 operated by PVCR case did not show an abnormal MEP result,neurological change was observed postoperatively. The sensitivity, specificity, percent of false negatives, and percent of false positives of MEP were 80.0%, 96.4%, 20.0%, and 3.6%, respectively. Conclusions: MEP monitoring is a useful method to detect neurological injury during high-risk spinal surgery with satisfactory specificity. For low sensitivity and a high false negative rate, increased monitoring of cases and continuous follow-up is needed. In conclusion, compression and distraction and PVCR are high-risk techniques in kyphotic deformity correction. Key Words: High-risk Spinal surgery, Motor Evoked Potential (MEP), Operative technique, Neurological complication

KEYWORDS

High-risk Spinal surgery, Motor Evoked Potential (MEP), Operative technique, Neurological complication

Citation status

* References for papers published after 2023 are currently being built.

[journal] Bridwell KH / 1998 / Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients. Incidence and etiology at one institution / Spine (Phila Pa 1976) 23 : 324~331

[journal] Nuwer MR / 1998 / Spinal cord monitoring with somatosensory techniques / J Clin Neurophysiol 15 : 183~193

[journal] Constantini S / 2000 / Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults / J Neurosurg 93 : 183~193

[journal] Cristante L / 1994 / Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity / Neurosurgery 35 : 69~74

[journal] Shin BJ / 2002 / Intraoperative Spinal Nerve Root Injuries during Surgery for Degenerative Low Back Disease / J Korean Soc Spine Surg 9 : 142~147

[journal] Ahn DK / 2007 / The Result of Early Decompression of Progressive Neurologic Deficit after Spine Surgery: A Case Report / J Korean Soc Spine Surg 14 : 201~206

[journal] Pechstein U / 1998 / Isoflurane plus nitrous oxide versus propofol for recording of motor evoked potentials after high frequency repetitive electrical stimulation / Electroencephalogr Clin Neurophysiol 108 : 175~181

[journal] Minto CF / 1997 / Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development / Anesthesiology 86 : 10~23

[journal] Langeloo DD / 2003 / Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients / Spine (Phila Pa 1976) 28 : 1043~1050

[journal] Lesser RP / 1986 / Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials / Ann Neurol 19 : 22~25

[journal] Nuwer MR / 1995 / Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey / Electroencephalogr Clin Neurophysiol 96 : 6~11

[journal] Cioni B / 1999 / Intraoperative motor evoked potentials monitoring in spinal neurosurgery / Arch Ital Biol 137 : 115~126

[journal] Jones SJ / 1996 / Motor evoked potential monitoring during spinal surgery: responses of distal limb muscles to transcranial cortical stimulation with pulse trains / Electroencephalogr Clin Neurophysiol 100 : 375~383

[journal] Oro J / 1992 / Effects of altering core body temperature on somatosensory and motor evoked potentials in rats / Spine (Phila Pa 1976) 17 : 498~503

[journal] Quinones-Hinojosa A / 2005 / Changes in transcranial motor evoked potentials during intramedullary spinal cord tumor resection correlate with postoperative motor function / Neurosurgery 56 : 982~993

[journal] Stoltze D / 2008 / Correction of post-traumatic and congenital kyphosis: indications, techniques, results / Orthopade 37 : 321~338

[journal] Gonzalez AA / 2009 / Intraoperative neurophysiological monitoring during spine surgery: a review / Neurosurg Focus 27 : 6~

[journal] Lieberman JA / 2008 / The efficacy of motor evoked potentials in fixed sagittal imbalance deformity correction surgery / Spine (Phila Pa 1976) 33 : 414~424

[journal] Sutter MA / 2007 / Multimodal intraoperative monitoring (MIOM)during 409 lumbosacral surgical procedures in 409 patients / Eur Spine J 16(2 Suppl) : 221~228

[journal] Mummaneni PV / 2008 / Pedicle subtraction osteotomy / Neurosurgery 63(3 Suppl) : 171~176

[journal] Cheh G / 2008 / Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do / Spine (Phila Pa 1976) 33 : 1093~1099

[journal] Kamerlink JR / 2010 / Major intraoperative neurologic monitoring deficits in consecutive pediatric and adult spinal deformity patients at one institution / Spine (Phila Pa 1976) 35 : 240~245

[journal] Suk SI / 2005 / Posterior vertebral column resection in fixed lumbosacral deformity / Spine (Phila Pa 1976) 30 : 703~710

[journal] Suk SI / 2005 / Posterior vertebral column resection for severe rigid scoliosis / Spine (Phila Pa 1976) 30 : 1682~1687

[journal] Gill JB / 2008 / Corrective osteotomies in spine surgery / J Bone Joint Surg Am 90 : 2509~2520

[journal] Suk SI / 2000 / Indications of proximal thoracic curve fusion in thoracic adolescent idiopathic scoliosis: recognition and treatment of double thoracic curve pattern in adolescent idiopathic scoliosis treated with segmental instrumentation / Spine (Phila Pa 1976) 25 : 2342~2349

[book] Lonstein JE / 1995 / Cord compression in: Moe’s textbook of scoliosis and other spinal deformities 3rd ed / WB Saunders Co : 534~540

[journal] Calancie B / 1998 / Threshold-level multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring / J Neurosurg 88 : 457~470

[journal] Modi HN / 2009 / False-negative transcranial motor-evoked potentials during scoliosis surgery causing paralysis: a case report with literature review / Spine (Phila Pa 1976) 34 : 896~900

[journal] Chen X / 2007 / Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deficits / J Clin Neurophysiol 24 : 281~285

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