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Use of transcranial motor-evoked potentials to provide reliable intraoperative neuromonitoring for the Charcot–Marie–Tooth population undergoing spine deformity surgery

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Abstract

Purpose

Intraoperative neuromonitoring (IONM) has historically been difficult to obtain in patients with Charcot–Marie–Tooth (CMT) disease. Transcranial motor-evoked potentials (TcMEPs) have been found to be safe and effective for other spinal deformity patients. Our objective was to determine the effectiveness of TcMEP monitoring in patients with CMT.

Methods

An IRB-approved, retrospective review of CMT patients undergoing spinal deformity surgery assessing TcMEP, somatosensory-evoked potential (SSEP), and neurogenic motor evoked potential (NMEP) IONM was performed. A 2:1 matched cohort control group of idiopathic spinal deformity patients was used. A waveform grading system was applied to review baseline TcMEP reliability and quality, which was validated via intraclass correlation coefficient amongst five raters.

Results

Twenty-three CMT patients (26 surgical cases) were identified. The use of TcMEP improved the ability to obtain baseline IONM when compared to SSEP (83% vs. 20%; p < 0.001) and NMEP (83% vs. 18%; p = 0.003). Baseline monitoring was obtained less often for CMT patients using SSEP (20% vs. 100%; p < 0.001) and TcMEP (83% vs. 100%; p = 0.111) compared to idiopathic patients. Sweep length (time from stimulation waveform evaluation) and maximum stimulation voltage were higher in the CMT group (289 ms vs. 111 ms p = 0.007 and 740 V vs. 345 V p = 0.089, respectively).

Conclusion

TcMEP monitoring significantly improves the ability to provide IONM for CMT patients undergoing spinal deformity surgery. Utilizing longer sweep lengths enhances the ability to attain baseline TcMEP readings, allowing surgeons to more safely proceed with surgery for these complex patients.

Level of evidence

Therapeutic-Level III.

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Funding

This work was supported by the Texas Scottish Rite Hospital for Children.

Author information

Authors and Affiliations

  1. Division of Pediatric Orthopaedic Surgery, Children’s National Hospital, Washington, DC, 20010, USA

    Jeffrey Peck

  2. Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn Street, Dallas, TX, 75219, USA

    Kiley Poppino & Daniel Sucato

  3. Department of Neurology and Rehabilitation Medicine, Texas Scottish Rite Hospital, University of Texas Southwestern Medical Center, Dallas, TX, 75219, USA

    Steven Sparagana, Patricia Rampy & Spencer Freeman

  4. Research Department, Texas Scottish Rite Hospital, Dallas, TX, 75219, USA

    Chan-Hee Jo

Authors
  1. Jeffrey Peck
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  2. Kiley Poppino
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  3. Steven Sparagana
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  4. Patricia Rampy
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  5. Spencer Freeman
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  6. Chan-Hee Jo
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  7. Daniel Sucato
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Contributions

JP: concept, study design, acquisition, analysis, interpretation of data, drafting of manuscript, critical revision of manuscript, final approval of manuscript; KP: concept, study design, acquisition, analysis, critical revision of manuscript, final approval of manuscript; SS: acquisition, analysis, interpretation of data, critical revision of manuscript, final approval of manuscript; PR: acquisition, analysis, interpretation of data, critical revision of manuscript, final approval of manuscript; SF: acquisition, analysis, interpretation of data, critical revision of manuscript, final approval of manuscript; C-HJ: study design, acquisition, analysis, interpretation of data, critical revision of manuscript, final approval of manuscript; DS: concept, study design, acquisition, analysis, interpretation of data, critical revision of manuscript, final approval of manuscript.

Corresponding author

Correspondence to Daniel Sucato.

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Conflict of interest

Kiley Poppino, Steven Sparagana, Patricia Rampy, Spender Freeman, Chan-Hee Jo, and Daniel Sucato declare they have no conflicts of interest. Jeffrey B. Peck declares a relationship with Smith and Nephew, which consisted of Smith and Nephew providing funds to the Hospital for Special Surgery (HSS) for the purpose of advancing the hospital’s research endeavors during his fellowship there.

Ethics approval

The study was approved by the Texas Scottish Rite Hospital Institutional Review Board and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This investigation was IRB-approved.

Consent to participate

This was a retrospective chart review. A waiver of consent was applied to all study participants.

Consent for publication

A waiver of consent was applied for all study participants.

Available of data and material

The data pertaining to this study is available and accessible for review as allowed by the guidelines of our Institutional Review Board and other research regulatory entities.

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Not applicable.

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Peck, J., Poppino, K., Sparagana, S. et al. Use of transcranial motor-evoked potentials to provide reliable intraoperative neuromonitoring for the Charcot–Marie–Tooth population undergoing spine deformity surgery. Spine Deform 10, 411–418 (2022). https://doi.org/10.1007/s43390-021-00409-0

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  • DOI: https://doi.org/10.1007/s43390-021-00409-0

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