The diagnostic accuracy of neuromonitoring for detecting postoperative bowel and bladder dysfunction in spinal oncology surgery: a case series.

Autor: Silverstein JW; Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA. jsilverst2@northwell.edu.; Department of Clinical Neurophysiology, Neuro Protective Solutions, New York, NY, USA. jsilverst2@northwell.edu., D'Amico RS; Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA., Mehta SH; Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA., Gluski J; Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA., Ber R; Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA., Sciubba DM; Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA., Lo SL; Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
Jazyk: angličtina
Zdroj: Journal of neuro-oncology [J Neurooncol] 2024 Sep; Vol. 169 (2), pp. 409-422. Date of Electronic Publication: 2024 Jun 17.
DOI: 10.1007/s11060-024-04742-y
Abstrakt: Purpose: Postoperative bowel and bladder dysfunction (BBD) poses a significant risk following surgery of the sacral spinal segments and sacral nerve roots, particularly in neuro-oncology cases. The need for more reliable neuromonitoring techniques to enhance the safety of spine surgery is evident.
Methods: We conducted a case series comprising 60 procedures involving 56 patients, spanning from September 2022 to January 2024. We assessed the diagnostic accuracy of sacral reflexes (bulbocavernosus and external urethral sphincter reflexes) and compared them with transcranial motor evoked potentials (TCMEP) incorporating anal sphincter (AS) and external urethral sphincter (EUS) recordings, as well as spontaneous electromyography (s-EMG) with AS and EUS recordings.
Results: Sacral reflexes demonstrated a specificity of 100% in predicting postoperative BBD, with a sensitivity of 73.33%. While sensitivity slightly decreased to 64.71% at the 1-month follow-up, it remained consistently high overall. TCMEP with AS/EUS recordings did not identify any instances of postoperative BBD, whereas s-EMG with AS/EUS recordings showed a sensitivity of 14.29% and a specificity of 97.14%.
Conclusion: Sacral reflex monitoring emerges as a robust adjunct to routine neuromonitoring, offering surgeons valuable predictive insights to potentially mitigate the occurrence of postoperative BBD.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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