Predicting intraoperative feasibility of combined TES-mMEP and cSSEP monitoring during scoliosis surgery based on preoperative neurophysiological assessment

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• 作者：Eric Azabou ; MD^a ; ^b ; ^c ; ^{eric.azabou@rpc.ap-hop-paris.fr" class="auth_mail} ; ^{eric.azabou@uvsq.fr" class="auth_mail} ; Vé ; ronique Manel ; MD^b ; Kariman Abelin-Genevois ; MD^d ; Nathalie Andre-Obadia ; MD^b ; Vincent Cunin ; MD^d ; Christophe Garin ; MD^d ; Remi Kohler ; MD ; PhD^d ; Jé ; rô ; me Berard ; MD ; PhD^d ; Sedat Ulkatan ; MD ; PhD^c
• 关键词：Intraoperative monitoring ; Scoliosis ; Surgery ; Motor evoked potentials ; Somatosensory evoked potentials ; Feasibility ; Preoperative procedures ; Planning ; Decision tree
• 刊名：The Spine Journal
• 出版年：1 July 2014
• 年：2014
• 卷：14
• 期：7
• 页码：1214-1220
• 全文大小：722 K

文摘

Combined monitoring of muscle motor evoked potentials elicited by transcranial electric stimulation (TES-mMEP) and cortical somatosensory evoked potentials (cSSEPs) is safe and effective for spinal cord monitoring during scoliosis surgery. However, TES-mMEP/cSSEP is not always feasible. Predictors of feasibility would help to plan the monitoring strategy.

Purpose

To identify predictors of the feasibility of TES-mMEP/cSSEP during scoliosis surgery.

Study design/setting

Prospective cohort study in a clinical neurophysiology unit and pediatric orthopedic department of a French university hospital.

Patient sample

A total of 103 children aged 2 to 19 years scheduled for scoliosis surgery.

Outcome measures

Feasibility rate of intraoperative TES-mMEP/cSSEP monitoring.

Methods

All patients underwent a preoperative neurological evaluation and preoperative mMEP and cSSEP recordings at both legs. For each factor associated with feasibility, we computed sensitivity, specificity, positive predictive value (PPV), and negative predictive value. A decision tree was designed.

Results

Presence of any of the following factors was associated with 100% feasibility, 100% specificity, and 100% PPV: idiopathic scoliosis, normal preoperative neurological findings, and normal preoperative mMEP and cSSEP recordings. Feasibility was 0% in the eight patients with no recordable mMEPs or cSSEPs during preoperative testing. A decision tree involving three screening steps can be used to identify patients in whom intraoperative TES-mMEP/cSSEP is feasible.

Conclusions

Preoperative neurological and neurophysiological assessments are helpful for identifying patients who can be successfully monitored by TES-mMEP/cSSEP during scoliosis surgery.