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Spinal Cord Monitoring With Transcranial Motor Evoked Potentials in Patients With Neural Axis Abnormalities Undergoing Spinal Deformity Surgery

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Abstract

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Study Design: Retrospective, case-control study.

Objectives

To report the effectiveness of transcranial motor evoked potentials (TcMEPs) in patients undergoing scoliosis surgery with neural axis abnormalities (NAAs).

Summary of Background Data

Transcranial motor evoked potentials are a safe and sensitive modality to identify impending spinal cord injury in adolescent idiopathic scoliosis (AIS). Previous studies have analyzed somatosensory evoked potentials (SSEPs) and neurogenic motor evoked potentials in NAA patients, but to our knowledge, no study has addressed the use of TcMEPs in these patients.

Methods

We performed an institutional review board—approved retrospective review of a consecutive series of patients with NAA at a single institution and compared them with a consecutive series of AIS patients undergoing scoliosis surgery with spinal cord monitoring using TcMEP and SSEP We compared the ability to obtain baseline data and the incidence of critical changes in TcMEPs and SSEPs between groups and examined a correlation with postoperative neurologic deficits.

Results

We compared 38 patients with NAA (15 Chiari malformations, 12 syrinx, 7 tethered cords, and 4 spinal cord tumors) with 184 patients with AIS. The age was similar and preoperative curve magnitude was greater in the NAA group. Good baseline data were obtained less frequently in the NAA group for TcMEPs (94.7% vs. 100%; p <.001) and SSEPs (89.5% vs. 100%; p <.001). There was no statistical difference in critical deviation from baseline in the NAA group for TcMEPs (3 of 38 [7.9%] vs. 5 of 184 [2.7%]; p =.120) or SSEPs (0 of 38 vs. 3 of 184 [1.6%] (p =.430). There were no postoperative neurologic deficits in the NAA or AIS group.

Conclusions

The ability to obtain baseline spinal cord monitoring in patients with NAA approaches that of an AIS group and accurately identifies impending neurologic deficits with high sensitivity. Surgeons should be confident that TcMEP baseline data can be obtained in patients with spinal cord pathology and should trust critical changes in TcMEPs intraoperatively to prevent spinal cord injury.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Lexington Shriners Hospitals for Children, 1900 Richmond Road, Lexington, KY, 40502, USA

    Ryan D. Muchow MD

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

    Anna McClung BSN, RN, Patricia Rampy MS, R EP T, CNIM, Elizabeth Van Allen MS, R EP T, CNIM, Steven Sparagana MD & Daniel J. Sucato MD, MS

Authors
  1. Ryan D. Muchow MD
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  2. Anna McClung BSN, RN
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  3. Patricia Rampy MS, R EP T, CNIM
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  4. Elizabeth Van Allen MS, R EP T, CNIM
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  5. Steven Sparagana MD
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  6. Daniel J. Sucato MD, MS
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Correspondence to Ryan D. Muchow MD.

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Muchow, R.D., McClung, A., Rampy, P. et al. Spinal Cord Monitoring With Transcranial Motor Evoked Potentials in Patients With Neural Axis Abnormalities Undergoing Spinal Deformity Surgery. Spine Deform 1, 205–210 (2013). https://doi.org/10.1016/j.jspd.2013.02.002

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  • DOI: https://doi.org/10.1016/j.jspd.2013.02.002

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