Advertisement

European Spine Journal

, Volume 16, Supplement 2, pp 232–237 | Cite as

Current opinions and recommendations on multimodal intraoperative monitoring during spine surgeries

  • Martin SutterEmail author
  • Vedran Deletis
  • Jiri Dvorak
  • Andreas Eggspuehler
  • Dieter Grob
  • David MacDonald
  • Alfred Mueller
  • Francesco Sala
  • Tetsuya Tamaki
Original Article

Introduction

With the rapid development of imaging techniques and better understanding of structural and functional pathology of the spine and spinal cord there has been a worldwide increase in the number of spine surgeries performed, particularly in specialized interdisciplinary spine centers. In addition to the congenital and acquired deformities of the spine and relatively rare spinal cord tumors, common degenerative spine disease within the aging general population contributes to a growing number of pathologies with myelopathies. This is important because antecedent myelopathy increases spinal cord risk during surgical treatment. The possibility of having functional neurophysiological assessment during spine and spinal cord surgery was introduced in 1970s by applying somatosensory evoked potentials (SEPs) as well as spinal evoked potentials [15, 21, 32, 33].

Meanwhile these modalities and continuous EMG recording have been enhanced by the addition of corticospinal motor pathway...

Keywords

Spine surgery Intraoperative monitoring Evoked potential Guidelines 

Notes

Acknowledgments

The authors would like to acknowledge the support of Charles McCammon from the research department of Schulthess Clinic for organizing the consensus meeting and preparing the manuscript.

Conflict of interest statement None of the authors has any potential conflict of interest.

References

  1. 1.
    (1994) Guideline eleven: guidelines for intraoperative monitoring of sensory evoked potentials. American Electroencephalographic Society. J Clin Neurophysiol 11(1):77–87Google Scholar
  2. 2.
    Auerbach JD, Schwartz DM, Drummond DS, Jones KJ, Flynn JM, El-Gazzar Y, McPartland T, Bowe A, Laufer S, Pizzutillo P, Bowen R, Dormans JP (2006) Detection of impending neurologic injury during surgery for adolescent idiopathic scoliosis: a comparison of transcranial motor and somatosensory evoked potential monitoring in 1121 consecutive cases, in scoliosis research society 41st annual meeting and pre-meeting course SRS: Monterey California. Sept 13–16Google Scholar
  3. 3.
    Boyd SG, Rothwell JC, Cowan JM, Webb PJ, Morley T, Asselman P, Marsden CD (1986) A method of monitoring function in corticospinal pathways during scoliosis surgery with a note on motor conduction velocities. J Neurol Neurosurg Psychiatr 49(3):251–257PubMedCrossRefGoogle Scholar
  4. 4.
    Burke D, Nuwer MR, Daube J, Fischer C, Schramm J, Yingling CD, Jones SJ (1999) Intraoperative monitoring. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol Suppl 52:133–148PubMedGoogle Scholar
  5. 5.
    Cheh G, Lenke LG, Kim YJ, Daubs MD, Padberg A, Kuhns CA, Stobbs G, Hensley M (2006) Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do? In Scoliosis Research Society 41st annual meeting and pre-meeting course, MontereyGoogle Scholar
  6. 6.
    Cronin AJ (2002) Spinal cord monitoring. Curr Opin Orthop 13:188–192CrossRefGoogle Scholar
  7. 7.
    Deletis V (2002) Intraoperative neurophysiology and methodologies used to monitor the functional integrity of the motor system. In: Deletis V, Shils JL (eds) Neurophysiology in Neurosurgery. Academic, California, pp 25–51Google Scholar
  8. 8.
    Deletis V, Sala F (2001) The role of intraoperative neurophysiology in the protection or documentation of surgically induced injury to the spinal cord. Ann NY Acad Sci 939:137–144PubMedCrossRefGoogle Scholar
  9. 9.
    Deletis V, Sala F (2004) Intraoperative neurophysiological monitoring during spine surgery: an update. Curr Opin Orthop 15:154–158CrossRefGoogle Scholar
  10. 10.
    Eggspühler A, Sutter M, Grob D, Jeszenszky D, Dvorak J (2007) Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients. Eur Spine J (suppl.)Google Scholar
  11. 11.
    Eggspühler A, Sutter M, Grob D, Jeszenszky D, Porchet F, Dvorak J (2007) Multimodal intraoperative monitoring (MIOM) during cervical spine surgical procedures in 246 patients. Eur Spine J (suppl.)Google Scholar
  12. 12.
    Eggspühler A, Sutter M, Grob D, Porchet F, Jeszenszky D, Dvorak J (2007) Multimodal intraoperative monitoring (MIOM) during surgical decompression of thoracic spinal stenosis in 36 patients. Eur Spine J (suppl.)Google Scholar
  13. 13.
    Iwasaki H, Tamaki T, Yoshida M, Ando M, Yamada H, Tsutsui S, Takami M (2003) Efficacy and limitations of current methods of intraoperative spinal cord monitoring. J Orthop Sci 8(5):635–642PubMedCrossRefGoogle Scholar
  14. 14.
    Kothbauer K, Deletis V, Epstein F (1998)Motor evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures, http://www.aans.org/journals/online_j/may98/4-5-1
  15. 15.
    Kurokawa T (1972) Spinal cord action potentials evoked by epidural stimulation of the spinal cord––a report of human and animal record. Jpn J Electroenceph Electromyogr 1:64–66Google Scholar
  16. 16.
    Leppanen RE, Abnm D, American Society of Neurophysiological M (2005) Intraoperative monitoring of segmental spinal nerve root function with free-run and electrically-triggered electromyography and spinal cord function with reflexes and F-responses. A position statement by the American Society of Neurophysiological Monitoring. J Clin Monit Comput 19(6):437–461Google Scholar
  17. 17.
    Luk KD, Hu Y, Wong YW, Cheung KM (2001) Evaluation of various evoked potential techniques for spinal cord monitoring during scoliosis surgery. Spine 26(16):1772–1777PubMedCrossRefGoogle Scholar
  18. 18.
    Macdonald DB (2006) Intraoperative motor evoked potential monitoring: overview and update. J Clin Monit Comput 20(5):347–377PubMedCrossRefGoogle Scholar
  19. 19.
    Macdonald DB, Al Zayed Z (2007) Four-limb muscle motor evoked potential and optimized somatosensory evoked potential monitoring with decussation assessment: results in 206 thoraculumbar spine surgeries. Eur Spine J (suppl.)Google Scholar
  20. 20.
    Minahan RE, Sepkuty JP, Lesser RP, Sponseller PD, Kostuik JP (2001) Anterior spinal cord injury with preserved neurogenic ‘motor’ evoked potentials. Clin Neurophysiol 112(8):1442–1450PubMedCrossRefGoogle Scholar
  21. 21.
    Nash CL, Brodkey JS, Croft TJ (1972) A model for electrical monitoring of spinal cord function in scoliosis patients undergoing correction. J Bone Joint Surg Am 54A:197–198Google Scholar
  22. 22.
    Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE (1995) Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 96(1):6–11PubMedCrossRefGoogle Scholar
  23. 23.
    Olaverri JCR, De Blas G, Vallespir GP, Burgos J, Hevia E, Vicente J, Sanpera I, Domenech P, Maruenda J, Ignacio R (2006.) Triggered electromyographic threshold in the intercostals muscle to evaluate the accuracy of high thoracic pedicle screw placement. In Scoliosis Research Society 41st annual meeting and pre-meeting course, MontereyGoogle Scholar
  24. 24.
    Owen JH (1999) The application of intraoperative monitoring during surgery for spinal deformity. Spine 24(24):2649–2662PubMedCrossRefGoogle Scholar
  25. 25.
    Sala F, Faccioli F, Lanteri P, Gerosa M (2007) Surgery for intramedullary spinal cord tumors: the role of intraoperative neurophysiological monitoring. Eur Spine J (suppl.)Google Scholar
  26. 26.
    Sala F, Krzan MJ, Deletis V (2002) Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how? Childs Nerv Syst 18(6–7):264–287PubMedGoogle Scholar
  27. 27.
    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(6):1129–1143; discussion 1129–1143PubMedCrossRefGoogle Scholar
  28. 28.
    Sutter M, Eggspühler A, Grob D, Jeszenszky D, Benini A, Porchet F, Muller A, Dvorak J (2007) The validity of multimodal intraoperative monitoring (MIOM) in surgery of 109 spine and spinal cord tumors. Eur Spine J (suppl.)Google Scholar
  29. 29.
    Sutter M, Eggspühler A, Grob D, Jeszenszky D, Porchet F, Muller A, Dvorak J (2007) The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1017 cases. Eur Spine J (suppl.)Google Scholar
  30. 30.
    Sutter M, Eggspühler A, Grob D, Porchet F, Jeszenszky D, Dvorak J (2007) Mutlimodal intraoperative monitoring (MIOM) during lumbosacral surgical procedures in 409 patients. Eur Spine J (suppl.)Google Scholar
  31. 31.
    Sutter M, Eggspühler A, Muller A, Dvorak J (2007) Multimodal intraoperative monitoring: an overview of proposed methodology based on 1017 cases. Eur Spine J (suppl.)Google Scholar
  32. 32.
    Tamaki T (2007) History and development of intraoperative monitoring during spine surgery. Eur Spine JGoogle Scholar
  33. 33.
    Tamaki T, Yamashita T, Kobayashi H (1972) Spinal cord monitoring. Jpn J Electroenceph Electromyogr 1:196Google Scholar
  34. 34.
    Toleikis JR (2005) Intraoperative monitoring using somatosensory evoked potentials. A position statement by the American Society of Neurophysiological Monitoring. J Clin Monit Comput 19(3):241–258PubMedCrossRefGoogle Scholar
  35. 35.
    Toleikis JR, Carlvin AO, Shapiro DE, Schafer MF (1993) The use of dermatomal evoked responses during surgical procedures that use intrapedicular fixation of the lumbosacral spine. Spine 18(16):2401–2407PubMedCrossRefGoogle Scholar
  36. 36.
    Ulkatan S, Neuwirth M, Bitan F, Minardi C, Kokoszka A, Deletis V (2006) Monitoring of scoliosis surgery with epidurally recorded motor evoked potentials (D wave) revealed false results. Clin Neurophysiol 117(9):2093–2101PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Martin Sutter
    • 1
    Email author
  • Vedran Deletis
    • 3
  • Jiri Dvorak
    • 1
  • Andreas Eggspuehler
    • 1
  • Dieter Grob
    • 2
  • David MacDonald
    • 4
  • Alfred Mueller
    • 1
  • Francesco Sala
    • 5
  • Tetsuya Tamaki
    • 6
  1. 1.Department of Neurology/Spine UnitSchulthess ClinicZurichSwitzerland
  2. 2.Department of Orthopedic Surgery/Spine UnitSchulthess ClinicZurichSwitzerland
  3. 3.Department of AnesthesiologyUniversity Medical Center New YorkNew YorkUSA
  4. 4.Department of NeurosciencesKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
  5. 5.Department of Neurological and Visual SciencesUniversity Hospital VeronaVeronaItaly
  6. 6.Wakayama Rosai HospitalWakayamaJapan

Personalised recommendations