دورية أكاديمية
Transabdominal motor evoked potential neuromonitoring of lumbosacral spine surgery.
العنوان: | Transabdominal motor evoked potential neuromonitoring of lumbosacral spine surgery. |
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المؤلفون: | Allison DW; Department of Neurology, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA. Electronic address: ionmmonitoring@gmail.com., Verma A; Department of Neurology, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Holman PJ; Department of Neurosurgery, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Huang M; Department of Neurosurgery, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Trask TW; Department of Neurosurgery, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Barber SM; Department of Neurosurgery, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Cockrell AR; Department of Neurology, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Weber MR; Department of Neurology, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Brooks DW; Department of Neurology, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Delgado L; Department of Neurology, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Steele WJ; Department of Neurosurgery, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Sellin JN; Department of Neurosurgery, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Gressot LV; Department of Neurosurgery, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Lambert B; Department of Orthopedics, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Ma BB; Department of Neurology, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Faraji AH; Department of Neurosurgery, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA., Saifi C; Department of Orthopedics, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA. |
المصدر: | The spine journal : official journal of the North American Spine Society [Spine J] 2024 Sep; Vol. 24 (9), pp. 1660-1670. Date of Electronic Publication: 2024 Apr 27. |
نوع المنشور: | Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: Elsevier Science Inc Country of Publication: United States NLM ID: 101130732 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-1632 (Electronic) Linking ISSN: 15299430 NLM ISO Abbreviation: Spine J Subsets: MEDLINE |
أسماء مطبوعة: | Original Publication: New York, NY : Elsevier Science Inc., c2001- |
مواضيع طبية MeSH: | Evoked Potentials, Motor*/physiology, Humans ; Male ; Female ; Middle Aged ; Adult ; Retrospective Studies ; Aged ; Lumbar Vertebrae/surgery ; Intraoperative Neurophysiological Monitoring/methods ; Evoked Potentials, Somatosensory/physiology ; Electromyography ; Monitoring, Intraoperative/methods ; Lumbosacral Region/surgery |
مستخلص: | Background Context: Transcranial Motor Evoked Potentials (TcMEPs) can improve intraoperative detection of femoral plexus and nerve root injury during lumbosacral spine surgery. However, even under ideal conditions, TcMEPs are not completely free of false-positive alerts due to the immobilizing effect of general anesthetics, especially in the proximal musculature. The application of transcutaneous stimulation to activate ventral nerve roots directly at the level of the conus medularis (bypassing the brain and spinal cord) has emerged as a method to potentially monitor the motor component of the femoral plexus and lumbosacral nerves free from the blunting effects of general anesthesia. Purpose: To evaluate the reliability and efficacy of transabdominal motor evoked potentials (TaMEPs) compared to TcMEPs during lumbosacral spine procedures. Design: We present the findings of a single-center 12-month retrospective experience of all lumbosacral spine surgeries utilizing multimodality intraoperative neuromonitoring (IONM) consisting of TcMEPs, TaMEPs, somatosensory evoked potentials (SSEPs), electromyography (EMG), and electroencephalography. Patient Sample: Two hundred and twenty patients having one, or a combination of lumbosacral spine procedures, including anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), posterior spinal fusion (PSF), and/or transforaminal lumbar interbody fusion (TLIF). Outcome Measures: Intraoperative neuromonitoring data was correlated to immediate postoperative neurologic examinations and chart review. Methods: Baseline reliability, false positive rate, true positive rate, false negative rate, area under the curve at baseline and at alerts, and detection of preoperative deficits of TcMEPs and TaMEPs were compared and analyzed for statistical significance. The relationship between transcutaneous stimulation voltage level and patient BMI was also examined. Results: TaMEPs were significantly more reliable than TcMEPs in all muscles except abductor hallucis. Of the 27 false positive alerts, 24 were TcMEPs alone, and 3 were TaMEPs alone. Of the 19 true positives, none were detected by TcMEPs alone, 3 were detected by TaMEPs alone (TcMEPs were not present), and the remaining 16 true positives involved TaMEPs and TcMEPs. TaMEPs had a significantly larger area under the curve (AUC) at baseline than TcMEPs in all muscles except abductor hallucis. The percent decrease in TcMEP and TaMEP AUC during LLIF alerts was not significantly different. Both TcMEPs and TaMEPs reflected three preexisting motor deficits. Patient BMI and TaMEP stimulation intensity were found to be moderately positively correlated. Conclusions: These findings demonstrate the high reliability and predictability of TaMEPs and the potential added value when TaMEPs are incorporated into multimodality IONM during lumbosacral spine surgery. Competing Interests: Declaration of competing interests One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms. (Copyright © 2024 Elsevier Inc. All rights reserved.) |
فهرسة مساهمة: | Keywords: Intraoperative neuromonitoring; Lumbar lateral interbody fusion; Lumbosacral; Motor evoked potentials; Saphenous; Somatosensory evoked potentials; TaMEP; Transabdominal motor evoked potential |
تواريخ الأحداث: | Date Created: 20240430 Date Completed: 20240822 Latest Revision: 20240822 |
رمز التحديث: | 20240823 |
DOI: | 10.1016/j.spinee.2024.04.029 |
PMID: | 38685276 |
قاعدة البيانات: | MEDLINE |
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