Advertisement

European Spine Journal

, Volume 16, Supplement 2, pp 188–196 | Cite as

Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients

  • Andreas Eggspuehler
  • Martin A. Sutter
  • Dieter Grob
  • Dezsö Jeszenszky
  • Jiri Dvorak
Original Article

Abstract

A prospective study was performed on 217 patients who received MIOM during corrective surgery of spinal deformities between March 2000 and December 2005. Aim is to determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during corrective spine surgery. MIOM is becoming an increasingly used method of monitoring function during corrective spine surgery. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information regarding any neurological deficits during the operation. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 217 consecutive patients with spinal deformities of different aetiologies were monitored by means of MIOM during the surgical procedure. Out of which 201 patients presented true negative findings while one patient presented false negative and three patients presented false positive findings. Twelve patients presented true positive findings where neurological deficit after the operation was predicted. All neurological deficits in those 12 patients recovered completely. The sensitivity of MIOM applied during surgery of spinal deformities has been calculated of 92.3% and the specificity 98.5%. Based upon the results of this study MIOM is an effective method of monitoring the spinal cord and nerve root function during corrective surgery of spinal deformities and consequently improves postoperative results. The Wake-up test for surgical procedure of spinal deformities became obsolete in our institution.

Keywords

Spine surgery Deformities Intraoperative monitoring Sensitivity Specificity 

Notes

Acknowledgments

Dr. Lote Medicus fund for the financial support of the development of MIOM at the Schulthess Clinic. Dave O’Riordan and Charles McCammon for helping with the manuscript. Anne Mannion PhD for the critical review of the manuscript.

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

References

  1. 1.
    Amassian VE, Stewart M, Quirk GJ, Rosenthal JL (1987) Physiological basis of motor effects of a transient stimulus to cerebral cortex. Neurosurgery 20:74–93PubMedGoogle Scholar
  2. 2.
    Delank KS, Delank HW, Konig DP, Popken F, Furderer S, Eysel P (2005) Iatrogenic paraplegia in spinal surgery. Arch Orthop Trauma Surg 125:33–41PubMedCrossRefGoogle Scholar
  3. 3.
    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
  4. 4.
    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 28:1043–1050PubMedCrossRefGoogle Scholar
  5. 5.
    Luk KD, Hu Y, Wong YW, Cheung KM (2001) Evaluation of various evoked potential techniques for spinal cord monitoring during scoliosis surgery. Spine 26:1772–1777PubMedCrossRefGoogle Scholar
  6. 6.
    Noonan KJ, Walker T, Feinberg JR, Nagel M, Didelot W, Lindseth R (2002) Factors related to false- versus true-positive neuromonitoring changes in adolescent idiopathic scoliosis surgery. Spine 27:825–830PubMedCrossRefGoogle Scholar
  7. 7.
    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 96:6–11PubMedCrossRefGoogle Scholar
  8. 8.
    Sala F, Krzan MJ, Deletis V (2002) Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how? Childs Nerv Syst 18:264–287PubMedGoogle Scholar
  9. 9.
    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 (in press)Google Scholar
  10. 10.
    Sutter M, Eggspühler A, Muller A, Dvorak J (2007) Multimodal intraoperative monitoring: methodology. Eur Spine J (in preperation)Google Scholar
  11. 11.
    Tamaki T, Noguchi T, Takano H, Tsuji H, Nakagawa T, Imai K, Inoue S (1984) Spinal cord monitoring as a clinical utilization of the spinal evoked potential. Clin Orthop Relat Res 184:58–64PubMedGoogle Scholar
  12. 12.
    Vauzelle C, Stagnara P, Jouvinroux P (1973) Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop Relat Res 93:173–178PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Andreas Eggspuehler
    • 1
  • Martin A. Sutter
    • 1
  • Dieter Grob
    • 1
  • Dezsö Jeszenszky
    • 1
  • Jiri Dvorak
    • 1
  1. 1.Department of Neurology, Spine UnitSchulthess ClinicZürichSwitzerland

Personalised recommendations