Skip to main content
SpringerLink
Log in

Intra-operative MEP monitoring can work well in the patients with neural axis abnormality

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To explain the intra-operative transcranial motor evoked potential (MEP) monitoring can work well in patients with neural axis abnormality (NAA).

Methods

One hundred eighteen consecutive NAA and 334 adolescent idiopathic scoliosis (AIS) patients who underwent spinal deformity surgery between June 2010 and April 2013 in our spine center were included. The MEP data including the success rate of obtaining a baseline, amplitude, sensitivity and specificity were analyzed.

Results

High-efficiency MEPs baseline could be obtained in 117/118 NAA (74 congenital scoliosis, 32 neuromuscular scoliosis, 8 adult scoliosis, 3 congenital kyphoscoliosis and 1 neurofibromatosis scoliosis) and 334 AIS cases. They had an approximate level in success rate of MEPs baseline (99.2 vs. 99.7 %) and MEPs amplitude (317 μV, n = 118; vs. 312 μV, n = 334). The sensitivity and specificity for MEP were 100 and 98.2 % in patients with NAA. And the MEPs amplitude value fitted positive-skewed distribution in both of NAA and AIS.

Conclusions

Intraoperative MEP monitoring can be used accurately and satisfactorily in NAA patients and show no difference compared with AIS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Potenza V, Weinstein SL, Neyt JG (1998) Dysfunction of the spinal cord during spinal arthrodesis for scoliosis: recommendations for early detection and treatment. A case report. J Bone Joint Surg Am 80:1679–1683

    CAS  PubMed  Google Scholar 

  2. El-Hawary R, Sucato DJ, Sparagana S, McClung A, Van Allen E, Rampy P (2006) Spinal cord monitoring in patients with spinal deformity and neural axis abnormalities—a comparison with adolescent idiopathic scoliosis patients. Spine 31:E698–E706. doi:10.1097/01.brs.0000232707.98076.37

    Article  PubMed  Google Scholar 

  3. Gupta P, Lenke LG, Bridwell KH (1998) Incidence of neural axis abnormalities in infantile and juvenile patients with spinal deformity. Is a magnetic resonance image screening necessary? Spine 23:206–210

    Article  CAS  PubMed  Google Scholar 

  4. Malhotra NR, Shaffrey CI (2010) Intraoperative electrophysiological monitoring in spine surgery. Spine 35:2167–2179. doi:10.1097/BRS.0b013e3181f6f0d0

    Article  PubMed  Google Scholar 

  5. Langeloo DD, Journee HL, Polak B, de Kleuver M (2001) A new application of TCE-MEP: spinal cord monitoring in patients with severe neuromuscular weakness undergoing corrective spine surgery. J Spinal Disord 14:445–448

    Article  CAS  PubMed  Google Scholar 

  6. Nair MN, Ramakrishna R, Song K, Kinney G, Slimp J, Ko AL, Avellino AM (2010) Human motor evoked potential responses following spinal cord transection: an in vivo study. Neurosurg Focus 29:E4. doi:10.3171/2010.3.FOCUS09201

    Article  PubMed  Google Scholar 

  7. Feng B, Qiu GX, Shen JX, Zhang JG, Tian Y, Li SG, Zhao H, Zhao Y (2012) Impact of multimodal intraoperative monitoring during surgery for spine deformity and potential risk factors for neurological monitoring changes. J Spinal Disord Tech 25:E87–E93. doi:10.1097/Bsd.0b013e31824d2a2f

    Article  Google Scholar 

  8. Deletis V, Sala F (2008) Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts. Clin Neurophysiol 119:248–264. doi:10.1016/j.clinph.2007.09.135

    Article  PubMed  Google Scholar 

  9. Hayashi H, Kawaguchi M, Yamamoto Y, Inoue S, Koizumi M, Ueda Y, Takakura Y, Furuya H (2008) Evaluation of reliability of post-tetanic motor-evoked potential monitoring during spinal surgery under general anesthesia. Spine 33:E994–E1000. doi:10.1097/Brs.0b013e318188adfc

    Article  PubMed  Google Scholar 

  10. Lo YL, Dan YF, Tan YE, Fook-Chong S, Tan SB, Tan CT, Raman S (2006) Intraoperative monitoring study of ipsilateral motor evoked potentials in scoliosis surgery. Eur Spine J 15(Suppl 5):656–660. doi:10.1007/s00586-006-0190-0

    Article  PubMed  PubMed Central  Google Scholar 

  11. Schwartz DM, Sestokas AK, Dormans JP, Vaccaro AR, Hilibrand AS, Flynn JM, Li PM, Shah SA, Welch W, Drummond DS, Albert TJ (2011) Transcranial electric motor evoked potential monitoring during spine surgery: is it safe? Spine 36:1046–1049. doi:10.1097/BRS.0b013e3181ecbe77

    Article  PubMed  Google Scholar 

  12. Calancie B, Harris W, Broton JG, Alexeeva N, Green BA (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. doi:10.3171/jns.1998.88.3.0457

    Article  CAS  PubMed  Google Scholar 

  13. Krammer MJ, Wolf S, Schul DB, Gerstner W, Lumenta CB (2009) Significance of intraoperative motor function monitoring using transcranial electrical motor evoked potentials (MEP) in patients with spinal and cranial lesions near the motor pathways. Br J Neurosurg 23:48–55. doi:10.1080/02688690802563349

    Article  PubMed  Google Scholar 

  14. Hsu B, Cree AK, Lagopoulos J, Cummine JL (2008) Transcranial motor-evoked potentials combined with response recording through compound muscle action potential as the sole modality of spinal cord monitoring in spinal deformity surgery. Spine 33:1100–1106. doi:10.1097/BRS.0b013e31816f5f09

    Article  PubMed  Google Scholar 

  15. Calancie B, Harris W, Brindle GF, Green BA, Landy HJ (2001) Threshold-level repetitive transcranial electrical stimulation for intraoperative monitoring of central motor conduction. J Neurosurg 95:161–168

    CAS  PubMed  Google Scholar 

  16. Wilson-Holden TJ, Padberg AM, Lenke LG, Larson BJ, Bridwell KH, Bassett GS (1999) Efficacy of intraoperative monitoring for pediatric patients with spinal cord pathology undergoing spinal deformity surgery. Spine 24:1685–1692

    Article  CAS  PubMed  Google Scholar 

  17. Hoving EW, Haitsma E, Ophuis CMCO, Journee HL (2011) The value of intraoperative neurophysiological monitoring in tethered cord surgery. Childs Nerv Syst 27:1445–1452. doi:10.1007/s00381-011-1471-4

    Article  PubMed  PubMed Central  Google Scholar 

  18. Langeloo DD, Lelivelt A, Louis Journee H, Slappendel R, de Kleuver M (2003) Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine 28:1043–1050. doi:10.1097/01.BRS.0000061995.75709.78

    PubMed  Google Scholar 

  19. Kawaguchi M, Sakamoto T, Inoue S, Kakimoto M, Furuya H, Morimoto T, Sakaki T (2000) Low dose propofol as a supplement to ketamine-based anesthesia during intraoperative monitoring of motor-evoked potentials. Spine 25:974–979. doi:10.1097/00007632-200004150-00013

    Article  CAS  PubMed  Google Scholar 

  20. Nathan N, Tabaraud F, Lacroix F, Moulies D, Viviand X, Lansade A, Terrier G, Feiss P (2003) Influence of propofol concentrations on multipulse transcranial motor evoked potentials. Br J Anaesth 91:493–497

    Article  CAS  PubMed  Google Scholar 

  21. Deiner SG, Kwatra SG, Lin HM, Weisz DJ (2010) Patient characteristics and anesthetic technique are additive but not synergistic predictors of successful motor evoked potential monitoring. Anesth Analg 111:421–425. doi:10.1213/Ane.0b013e3181e41804

    Article  PubMed  Google Scholar 

  22. Moller AR, Ansari S, Cohen-Gadol AA (2011) Techniques of intraoperative monitoring for spinal cord function: their past, present, and future directions. Neurol Res 33:363–370. doi:10.1179/016164110x12807570510130

    Article  PubMed  Google Scholar 

  23. Eggspuehler A, Sutter MA, Grob D, Jeszenszky D, Dvorak J (2007) Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients. Eur Spine J 16(Suppl 2):S188–S196. doi:10.1007/s00586-007-0427-6

    Article  PubMed  Google Scholar 

  24. Pastorelli F, Di Silvestre M, Plasmati R, Michelucci R, Greggi T, Morigi A, Bacchin MR, Bonarelli S, Cioni A, Vommaro F, Fini N, Lolli F, Parisini P (2011) The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring. Eur Spine J 20(Suppl 1):S105–S114. doi:10.1007/s00586-011-1756-z

    Article  PubMed  Google Scholar 

  25. Quraishi NA, Lewis SJ, Kelleher MO, Sarjeant R, Rampersaud YR, Fehlings MG (2009) Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine 34:1504–1512. doi:10.1097/BRS.0b013e3181a87b66

    Article  PubMed  Google Scholar 

  26. Schwartz DM, Auerbach JD, Dormans JP, Flynn J, Drummond DS, Bowe JA, Laufer S, Shah SA, Bowen JR, Pizzutillo PD, Jones KJ, Drummond DS (2007) Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am 89:2440–2449. doi:10.2106/JBJS.F.01476

    Article  PubMed  Google Scholar 

  27. Fehlings MG, Brodke DS, Norvell DC, Dettori JR (2010) The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? Spine 35:S37–S46. doi:10.1097/BRS.0b013e3181d8338e

    Article  PubMed  Google Scholar 

  28. Muchow RD, McClung A, Rampy P, Van Allen E, Sparagana S, Sucato DJ (2013) Spinal cord monitoring with transcranial motor evoked potentials in patients with neural axis abnormalities undergoing spinal deformity surgery. Spine Deform 1:205–210

    Article  Google Scholar 

  29. Sala F, Palandri G, Basso E, Lanteri P, Deletis V, Faccioli F, Bricolo A (2006) Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery 58:1129–1143. doi:10.1227/01.NEU.0000215948.97195.58 (discussion 1129–1143)

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People’s Republic of China

      Shujie Wang, Qianyu Zhuang, Jianguo Zhang, Ye Tian, Hong Zhao, Yipeng Wang, Yu Zhao, Shugang Li, Xisheng Weng, Guixing Qiu & Jianxiong Shen

    Authors
    1. Shujie Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Qianyu Zhuang
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jianguo Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Ye Tian
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Hong Zhao
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Yipeng Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Yu Zhao
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Shugang Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Xisheng Weng
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Guixing Qiu
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Jianxiong Shen
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Jianxiong Shen.

    Ethics declarations

    Conflict of interest

    None.

    Additional information

    S. Wang and Q. Zhuang contributed equally to this paper.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Wang, S., Zhuang, Q., Zhang, J. et al. Intra-operative MEP monitoring can work well in the patients with neural axis abnormality. Eur Spine J 25, 3194–3200 (2016). https://doi.org/10.1007/s00586-015-4205-6

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00586-015-4205-6

    Keywords

    Search

    Navigation