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Multimodality intraoperative neuromonitoring in extreme lateral interbody fusion. Transcranial electrical stimulation as indispensable rearview

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Abstract

Purpose

To optimize intraoperative neuromonitoring during extreme lateral interbody fusion (XLIF) by adding transcranial electrical stimulation with motor evoked potential (TESMEP) to previously described monitoring using spontaneous EMG (sEMG) and peripheral stimulation (triggered EMG: tEMG).

Methods

Twenty-three patients with degenerative lumbar scoliosis had XLIF procedures and were monitored using sEMG, tEMG and TESMEP. Spontaneous and triggered muscle activity, and the MEP of 5 ipsilateral leg muscles, 2 contralateral leg muscles and 1 arm muscle were monitored.

Results

During XLIF surgery decreased MEP amplitudes were measured in 9 patients and in 6 patients sEMG was documented. In 4 patients, both events were described. In 30 % of the cases (n = 7), the MEP amplitude decreased immediately after breaking of the table and even before skin incision. After reduction of the table break, the MEP amplitudes recovered to baseline. In two patients, the MEP amplitude deteriorated during distraction of the psoas with the retractor, while no events were reported using sEMG and tEMG. Repositioning of the retractor led to recovery of the MEP.

Conclusions

Monitoring the complete nervous system during an XLIF procedure is found to be helpful since nerve roots, lumbar plexus as well as the intradural neural structures may be at risk. TESMEP has additional value to sEMG and tEMG during XLIF procedure: (1) it informed about otherwise unnoticed events, and (2) it confirmed and added information to events measured using sEMG.

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Authors and Affiliations

  1. Department of Anesthesiology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands

    Hanneke I. Berends & Ilona Rácz

  2. Ortho-Spine Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands

    Henricus L. Journée

  3. Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands

    Jan van Loon & Maarten Spruit

  4. Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, USA

    Roger Härtl

Authors
  1. Hanneke I. Berends
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  2. Henricus L. Journée
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  3. Ilona Rácz
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  4. Jan van Loon
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  5. Roger Härtl
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  6. Maarten Spruit
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Corresponding author

Correspondence to Hanneke I. Berends.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

AOSpine TK system funded the study. We thank them for providing the financial support.

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Berends, H.I., Journée, H.L., Rácz, I. et al. Multimodality intraoperative neuromonitoring in extreme lateral interbody fusion. Transcranial electrical stimulation as indispensable rearview. Eur Spine J 25, 1581–1586 (2016). https://doi.org/10.1007/s00586-015-4182-9

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  • DOI: https://doi.org/10.1007/s00586-015-4182-9

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