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Intraoperative evoked potentials in patients with ossification of posterior longitudinal ligament

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Abstract

Preoperative somatosensory evoked potentials (preSEPs) are used to evaluate the severity of myelopathy, and intraoperative neurophysiological monitoring (IONM) is used to reduce iatrogenic damage during operations. However, the correlation between preSEPs and IONM on postoperative neurologic deterioration (PND) in ossification of the posterior longitudinal ligament (OPLL) has not been studied. Thus, under the hypothesis that the patients with deteriorated preSEPs would be more likely to have significant changes in intraoperative SEPs (ioSEPs), and that this would be correlated with PND, we investigated the prognostic value of preSEPs on IONM and PND. This retrospective study included 265 patients who underwent preSEPs and IONM between January 2015 and July 2019. Muscle strength, the sensory scale of the Japanese Orthopaedic Association score examined within 3 days preoperatively, and at 48 h and 4 weeks postoperatively, was analysed. PreSEPs and intraoperative SEPs (ioSEPs) were recorded by stimulating the median and tibial nerves. Intraoperative motor evoked potentials (ioMEPs) were elicited by transcranial electrical stimulation over the motor cortex. PreSEPs latency prolongation of the median and tibial nerves showed significant correlations with ioSEPs. PMD at 48 h or 4 weeks after surgery correlated with ioSEPs and ioMEPs amplitudes. Postoperative sensory deterioration (PSD) at 48 h or 4 weeks after surgery correlated with latency prolongation of ioSEPs. There was a positive correlation between amount of blood loss and maximum percentage of ioSEPs latency prolongation and a negative correlation with PMD at 48 h and 4 weeks postoperatively. PreSEPs predict significant changes in ioSEPs. Furthermore, bleeding control is important to reduce PMD in OPLL.

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References

  1. Cerecedo-Lopez CD, Tafel I, Lak AM, Chi J, Lu Y, Groff M, Zaidi HA. Surgical management of ossification of the posterior longitudinal ligament in the cervical spine. J Clin Neurosci. 2019. https://doi.org/10.1016/j.jocn.2019.12.015.

    Article  PubMed  Google Scholar 

  2. Matsunaga S, Sakou T. Ossification of the posterior longitudinal ligament of the cervical spine: etiology and natural history. Spine (Phila Pa 1976). 2012;37(5):E309–14. https://doi.org/10.1097/BRS.0b013e318241ad33.

    Article  Google Scholar 

  3. Bednarik J, Kadanka Z, Vohanka S, Stejskal L, Vlach O, Schroder R. The value of somatosensory- and motor-evoked potentials in predicting and monitoring the effect of therapy in spondylotic cervical myelopathy. Prospective randomized study. Spine (Phila Pa 1976). 1999;24(15):1593–8. https://doi.org/10.1097/00007632-199908010-00014.

    Article  CAS  Google Scholar 

  4. Chiappa KH. Short-latency somatosensory evoked potentials: methodology. In: Chiappa KH, editor. Evoked potentials in clinical medicine. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1997. p. 283–340.

    Google Scholar 

  5. Klem GH, Lüders HO, Jasper H, Elger C. The ten-twenty electrode system of the International Federation. Electroencephalogr Clin Neurophysiol. 1999;52(3):3–6.

    CAS  Google Scholar 

  6. Krammer MJ, Wolf S, Schul DB, Gerstner W, Lumenta CB. 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. 2009;23(1):48–55. https://doi.org/10.1080/02688690802563349.

    Article  PubMed  Google Scholar 

  7. Cruccu G, Aminoff MJ, Curio G, Guerit JM, Kakigi R, Mauguiere F, Rossini PM, Treede RD, Garcia-Larrea L. Recommendations for the clinical use of somatosensory-evoked potentials. Clin Neurophysiol. 2008;119(8):1705–19. https://doi.org/10.1016/j.clinph.2008.03.016.

    Article  CAS  PubMed  Google Scholar 

  8. Berthier E, Tuijman F, Mauguiere F. Diagnostic utility of somatosensory evoked potentials (SEPs) in presurgical assessment of cervical spondylotic myelopathy. Clin Neurophysiol. 1996;26(5):300–10.

    Article  CAS  Google Scholar 

  9. Kikuchi Y, Baba H, Kawahara N, Nagata S, Tomita K, Nomura S, Yugami H. Experience of diagnosis of thoracic myelopathy using spinal cord evoked potentials. Spinal Cord Monitoring and Electrodiagnosis. Berlin: Springer; 1991. p. 461–71.

    Google Scholar 

  10. Hu Y, Ding Y, Ruan D, Wong YW, Cheung KM, Luk KD. Prognostic value of somatosensory-evoked potentials in the surgical management of cervical spondylotic myelopathy. Spine. 2008;33(10):E305–10.

    Article  Google Scholar 

  11. Restuccia D, Di Lazzaro V, Valeriani M, Aulisa L, Galli M, Tonali P, Maugière F. The role of upper limb somatosensory evoked potentials in the management of cervical spondylotic myelopathy: preliminary data. Electroencephalogr Clin Neurophysiol/Evoked Potentials Sect. 1994;92(6):502–9.

    Article  CAS  Google Scholar 

  12. Wang S, Tian Y, Lin X, Ren Z, Zhao Y, Zhai J, Zhang X, Zhao Y, Dong Y, Zhao C. Comparison of intraoperative neurophysiologic monitoring outcomes between cervical and thoracic spine surgery. Eur Spine J. 2017;26(9):2404–9.

    Article  Google Scholar 

  13. Mayer M, Meier O, Auffarth A, Koller H. Cervical laminectomy and instrumented lateral mass fusion: techniques, pearls and pitfalls. Eur Spine J. 2015;24(2):168–85.

    Article  Google Scholar 

  14. Yoon S, Park T, Eun N, Park Y. The cutoff value of ossification of posterior longitudinal ligament (OPLL) for early diagnosis of myelopathy using somatosensory evoked potential in cervical OPLL patients. Spinal Cord. 2017;55(6):606–11.

    Article  CAS  Google Scholar 

  15. Smith ZA, Buchanan CC, Raphael D, Khoo LT. Ossification of the posterior longitudinal ligament: pathogenesis, management, and current surgical approaches: a review. Neurosurg Focus. 2011;30(3):E10.

    Article  Google Scholar 

  16. Kale S, Mahapatra A. The role of somatosensory evoked potentials in spinal dysraphism–do they have a prognostic significance? Child’s Nervous Syst. 1998;14(7):328–31.

    Article  CAS  Google Scholar 

  17. Kang H, Gwak HS, Shin SH, Woo MK, Jeong IH, Yoo H, Kwon JW, Lee SH. Monitoring rate and predictability of intraoperative monitoring in patients with intradural extramedullary and epidural metastatic spinal tumors. Spinal Cord. 2017;55(10):906–10. https://doi.org/10.1038/sc.2017.43.

    Article  CAS  PubMed  Google Scholar 

  18. Kelleher MO, Tan G, Sarjeant R, Fehlings MG. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine. 2008;8(3):215–21.

    Article  Google Scholar 

  19. Weinzierl M, Reinacher P, Gilsbach J, Rohde V. Combined motor and somatosensory evoked potentials for intraoperative monitoring: intra-and postoperative data in a series of 69 operations. Neurosurg Rev. 2007;30(2):109–16.

    Article  CAS  Google Scholar 

  20. Ghadirpour R, Nasi D, Iaccarino C, Giraldi D, Sabadini R, Motti L, Sala F, Servadei F. Intraoperative neurophysiological monitoring for intradural extramedullary tumors: why not? Clin Neurol Neurosurg. 2015;130:140–9.

    Article  Google Scholar 

  21. Hyun SJ, Rhim S, Kang J, Hong S, Park B. Combined motor-and somatosensory-evoked potential monitoring for spine and spinal cord surgery: correlation of clinical and neurophysiological data in 85 consecutive procedures. Spinal Cord. 2009;47(8):616–22.

    Article  CAS  Google Scholar 

  22. Pelosi L, Lamb J, Grevitt M, Mehdian S, Webb J, Blumhardt L. Combined monitoring of motor and somatosensory evoked potentials in orthopaedic spinal surgery. Clin Neurophysiol. 2002;113(7):1082–91.

    Article  Google Scholar 

  23. Pastorelli F, Di Silvestre M, Plasmati R, Michelucci R, Greggi T, Morigi A, Bacchin M, Bonarelli S, Cioni A, Vommaro F. The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring. Eur Spine J. 2011;20(1):105–14.

    Article  Google Scholar 

  24. Park T, Park J, Park YG, Lee J. Intraoperative neurophysiological monitoring for spinal cord tumor surgery: comparison of motor and somatosensory evoked potentials according to tumor types. Ann Rehabil Med. 2017;41(4):610–20. https://doi.org/10.5535/arm.2017.41.4.610.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hitchon PW, Dyste GN, Osenbach RK, Jensen AE. Response of spinal cord blood flow and motor and sensory evoked potentials to aortic ligation. Surg Neurol. 1990;34(5):279–85. https://doi.org/10.1016/0090-3019(90)90002-7.

    Article  CAS  PubMed  Google Scholar 

  26. Elmore JR, Gloviczki P, Harper CM, Pairolero PC, Murray MJ, Bourchier RG, Bower TC, Daube JR. Failure of motor evoked potentials to predict neurologic outcome in experimental thoracic aortic occlusion. J Vasc Surg. 1991;14(2):131–9. https://doi.org/10.1067/mva.1991.29237.

    Article  CAS  PubMed  Google Scholar 

  27. Nukada H, Dyck PJ. Acute ischemia causes axonal stasis, swelling, attenuation, and secondary demyelination. Ann Neurol. 1987;22(3):311–8.

    Article  CAS  Google Scholar 

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Acknowledgements

We would like to thank Department of Biostatstics, college of medicine, the Gangnam Severance Hospital of Korea for help with the statistical analysis, and Editage (www.editage.co.kr) for English language editing.

Funding

There was no funding or support in this study.

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06229, Republic of Korea

    Myungeun Yoo, Yoon Ghil Park, Chae Hwan Lim, Seok Young Chung, Dawoon Kim & Jinyoung Park

  2. Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Yong Eun Cho

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  1. Myungeun Yoo
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Correspondence to Jinyoung Park.

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All procedures in this study were in accordance with the ethical standards of the Institutional Review Board of Gangnam Severance Hospital with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived, because it was retrospective study and does not expose patient-identifiable information.

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Yoo, M., Park, Y.G., Cho, Y.E. et al. Intraoperative evoked potentials in patients with ossification of posterior longitudinal ligament. J Clin Monit Comput 36, 247–258 (2022). https://doi.org/10.1007/s10877-020-00646-0

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  • DOI: https://doi.org/10.1007/s10877-020-00646-0

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