Application of evoked potential monitoring in spinal surgery
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Objective Intraoperative electrophysiological monitoring is gaining a wider application in spinal surgery.The present article is to explore the application value of somatosensory evoked potential(SEP) and motor evoked potential(MEP) in spinal surgery.Methods We employed both SEP and MEP for dynamic monitoring of 7 cases of spinal surgery,and adopted SEP alone for another 3.Results SEP was successfully induced and recorded in all the cases,while MEP only in 3 cases.Compared with preoperative forewarning potential,the wave amplitude of SEP was decreased during intraoperative monitoring in 2 cases,but restored to normal after the operation was stopped or the surgical methods adjusted.One case showed obviously improved symptoms after surgery though with an increased wave amplitude of SEP during intraoperative monitoring.No significant changes were observed in either amplitude or latency of the wave in the 3 cases with MEP recorded.Conclusion Evoked potential monitoring,especially with combined SEP and MEP during spinal surgery,can effectively reduce mechanical damage to nerves,increase the success rate of resection,and raise the confidence of the surgeons.Keywords:
Somatosensory evoked potential
Spinal Surgery
Evoked potential
Intraoperative neurophysiological monitoring
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Objective To explore the technologies accuracy,influencing factors and clinical application value of spinal somatosensory evoked potential.Methods 120 cases of spinal surgery with intraoperative cortical somatosensory evoked potential(Cortical somatosensory evoked potential,CSEP) monitoring,observation of preoperative,intraoperative and postoperative as well as important changes in surgical procedures of the CSEP,combined with changes in spinal cord function after operation to determine CSEP accuracy and clinical value.Results In 120 cases,CSEP testing surgery in 112(93.3%) patients without spinal cord dysfunction;6 cases(5%) patients intraoperative CSEP to the value of the standard warning,warning surgeons to pay attention to surgical operation,surgery with non-spinal cord injury,proprioception no exception;a false positive in 2 cases,after the normal proprioception.Conclusion The exclusion of various interference factors of somatosensory evoked potentials can be more accurate monitoring of spinal cord function,is a good clinical value of spinal surgery monitoring technology.
Somatosensory evoked potential
Spinal Surgery
Evoked potential
Proprioception
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Objective:To study how to increase the accuracy of somatosensory evoked potential in spinal cord monitoring during spinal surgery.Method:The cortical somatosensory evoked potential(CSEP) were used to monitor the spinal cord function during surgery and the CSEP were also recorded before and after surgery so that the accuracy of CSEP can be judged by comparison.Result:In 78 cases,71 cases did not reach the warning standards;5 cases reached the warning standards during surgery and the surgeons were warned to take accurate steps to finish the operations;one case was false positive and another was false negative,there were no spinal cord deterioration after surgery.Conclusion:With the cooperation of electrical physician,anesthetist and surgeon,the somatosensory evoked potential can reflect the physiological and pathophysiologiacl conditions of spinal cord after ruling out the interfering factors.
Somatosensory evoked potential
Evoked potential
Spinal Surgery
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Somatosensory evoked potential
Evoked potential
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There has been little enthusiasm for somatosensory evoked potential monitoring in cervical spine surgery as a result, in part, of the increased risk of motor tract injury at this level, to which somatosensory monitoring may be insensitive. Transcranial electric motor evoked potential monitoring allows assessment of the motor tracts; therefore, we compared transcranial electric motor evoked potential and somatosensory evoked potential monitoring during cervical spine surgery to determine the temporal relationship between the changes in the potentials demonstrated by each type of monitoring and neurological sequelae and to identify patient-related and surgical factors associated with intraoperative neurophysiological changes.Somatosensory evoked potential and transcranial electric motor evoked potential data recorded for 427 patients undergoing anterior or posterior cervical spine surgery between January 1999 and March 2001 were analyzed. All patients who showed substantial (at least 60%) or complete unilateral or bilateral amplitude loss, for at least ten minutes, during the transcranial electric motor evoked potential and/or somatosensory evoked potential monitoring were identified.Twelve of the 427 patients demonstrated substantial or complete loss of amplitude of the transcranial electric motor evoked potentials. Ten of those patients had complete reversal of the loss following prompt intraoperative intervention, whereas two awoke with a new motor deficit. Somatosensory evoked potential monitoring failed to identify any change in one of the two patients, and the change in the somatosensory evoked potentials lagged behind the change in the transcranial electric motor evoked potentials by thirty-three minutes in the other. No patient showed loss of amplitude of the somatosensory evoked potentials in the absence of changes in the transcranial electric motor evoked potentials. Transcranial electric motor evoked potential monitoring was 100% sensitive and 100% specific, whereas somatosensory evoked potential monitoring was only 25% sensitive; it was, however, 100% specific.Transcranial electric motor evoked potential monitoring appears to be superior to conventional somatosensory evoked potential monitoring for identifying evolving motor tract injury during cervical spine surgery. Surgeons should strongly consider using this modality when operating on patients with cervical spondylotic myelopathy in general and on those with ossification of the posterior longitudinal ligament in particular.
Somatosensory evoked potential
Evoked potential
Intraoperative neurophysiological monitoring
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Spine and spinal cord surgery carries a significant risk of neurological impairment Intraoperative neurological monitoring should now include not only somatosensory evoked potential (SEP), but also motor evoked potential (MEP). While SEP monitors the posterior cord, MEP provides better information regarding the status of the anterior/anterolateral cord. The multimodality SEP and MEP monitoring essentially covers physiological changes of the entire cord, and thereby reduces the risk of development of irreversible neural injury. A 50% drop in SEP amplitude is the universally accepted warning criteria. Conversely, different warning criteria for MEP have been proposed because of MEP especially sensitive to the effects of anesthetic agents. Although evidence lacks that intraoperative evoked potential reduces the rate of neurologic deficits, it is recommended to monitor MEP for spine and spinal surgery, when the spinal cord is considered to be at risk. The anesthesiologist must be familiar with SEP and MEP monitoring to increase the preciseness of the monitoring.
Evoked potential
Somatosensory evoked potential
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Spinal Surgery
Intraoperative neurophysiological monitoring
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Objective:To explore the clinical application of monitoring by combination of spinal somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) during operation for patients with spinal cord or vertebral column disorders. Methods:Eighteen patients with spinal cord or vertebral column disorders were monitored by the combination of SEP and MEP. Japanese Orthorpaedic Association Score (JOAS) was adopted to evaluate the patients’ clinical nervi function.Results:Slight fluctuation of the amplitude of both N1 and P1 of SEP appeared transiently in 18 patients during the operation and the latencies of SEPs were consistent with the first recordings. Both the amplitude and latencies of D1 of spinal MEPs recorded at operation were the same as those recorded after the operation in 8 patients receiving orthopaedic operation. The amplitude of D1 of MEPs decreased in 10 patients with spinal disorders but resumed to normal after a brief rest and changing the operative direction. JOA scores improved significantly after operation than those before operation. Conclusion:The waveform of either SEPs or MEPs might be stable and reliable in monitoring patients during operation. It might be helpful in avoiding “false negative and/or false positive results” as well as the postoperative nervi dysfunction.
Somatosensory evoked potential
Evoked potential
Vertebral column
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Purpose: Although there are guidelines analyzing transcranial motor evoked potentials (MEP) waveform criteria, they vary widely and are not applied universally during intraoperative neurophysiologic monitoring (IONM). The objective is to generate hypotheses to identify early and reliable MEP waveform characteristics prior to complete loss of MEP to predict impending motor spinal cord injuries during spinal surgeries. The ultimate goal is to enhance real-time feedback to prevent injury or detect reversible spinal cord damage.Methods: Fifteen true positive cases of persistent intraoperative MEP loss and new postoperative motor deficits were retrospectively identified from 2011 to 2013. Waveform characteristics of latency, amplitude, duration, phases, and area-under-the-curve (AUC) were measured, and an intraoperative spinal cord index (ISCI) was calculated for 5 traces prior to complete MEP loss. ISCI = [amplitude x duration x (phases+1) x AUC]/latency.Results: Out of 22 muscles in 15 cases, latency increased in 2, duration decreased in 12, amplitude decreased in 13, AUC decreased in 13, and ISCI decreased in 14. In 11 out of 15 cases (73%), ISCI dropped > 40% in at least one muscle before MEP were completely lost. Thirteen cases had concurrent somatosensory evoked potentials (SSEP) changes, 9 out of 13 had > 50% decrease in SSEP: 2 out of 9 changed before MEP, 5 out of 9 simultaneously, and 2 out of 9 after.Conclusions: In these cases of motor injury, smaller and simpler MEP waveforms preceded complete loss of signal. An ISCI 40% drop could be tested as a warning threshold for impending motor compromise in future prospective studies and lead to eventual standardization to predict irreversible postoperative deficits.
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A review of our experience with evoked potential monitoring of over 100 spinal procedures is summarized here. Typical results of somatosensory cortical evoked potential (SCEP) testing found that latency of responses increased slightly and amplitude decreased substantially from preanesthesia to predistraction with no further changes. SCEP results are effected by many factors, but when they are understood and recognized, evoked potential monitoring can play a significant role in recognizing potential problems and preventing postoperative neurological problems in patients undergoing spinal surgery.
Somatosensory evoked potential
Evoked potential
Spinal Surgery
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Objective To investigate the reliability,superiority and value of combined monitoring of motor evoked potentials(MEP) and somatosensory evoked potentials(SEP) during intramedullary spinal cord tumor surgery under total intravenous anesthesia.Method 72 patients with intramedullary spinal cord tumor were monitored somatosensory evoked potentials and muscle motor evoked potentials during operation.McCormick scale was adopted to evaluate the patients' clinical nerve function.The postoperative to preoperative McCormick grade variation and combimed monitoring of SEP and MEP were compared in this group.Result 14 patients' nerve function was improved.The findings of monitoring were evaluated in 18 patients with depressed McCormick scores.There was significant difference in the latency and amplitude of waves between pretreatment and post-treatment (P＜0.05).The changes of SEP and MEP were correlative with the changes of spinal cord function.Conclusion Combined monitoring of SEP and MEP could help to improve postoperative McCormick scale outcome significantly for patients with intramedullary spinal cord tumor.The waveform of either SEP or MEP might be stable and reliabie in monitoring patients under total intravenous anesthesia.It might be helpful in avoiding 'false negative and/or false positive results'as well as the postoperative neurological sequelae.
Key words:
Spinal cord; Somatosensory evoked potentials; Motor evoked potentials
Somatosensory evoked potential
Evoked potential
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