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

Abstract

BACKGROUND CONTEXT:

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.

• Authors: Eric Azabou, Véronique Manel, Kariman Abelin-Genevois, Nathalie Andre-Obadia, Vincent Cunin, Christophe Garin, Remi Kohler, Jérôme Berard, Sedat Ulkatan
• Journal: The spine journal : official journal of the North American Spine Society (Spine J) Vol. 14 Issue 7 Pg. 1214-20 (Jul 01 2014) ISSN: 1878-1632 [Electronic] United States
• PMID: 24200409 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Child
• Child, Preschool
• Cohort Studies
• Evoked Potentials, Motor (physiology)
• Evoked Potentials, Somatosensory (physiology)
• Female
• Humans
• Male
• Monitoring, Intraoperative (methods)
• Scoliosis (physiopathology, surgery)
• Sensitivity and Specificity
• Spinal Cord (physiopathology)
• Transcranial Direct Current Stimulation
• Young Adult