The Efficacy of Intraoperative Neurophysiological Monitoring to Detect Postoperative Neurological Deficits in Transforaminal Lumbar Interbody Fusion Surgery
| Autor: | Benjamin Tran, Joung Heon Kim, Svetlana Lenina, Grace E. Mosley, Jun S. Kim, Samuel K. Cho, Joshua J Meaike |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Intraoperative Neurophysiological Monitoring medicine.medical_treatment Sensory system Electromyography 030218 nuclear medicine & medical imaging Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Lumbar Lumbar interbody fusion Evoked Potentials Somatosensory medicine Humans Aged Retrospective Studies Aged 80 and over Lumbar Vertebrae medicine.diagnostic_test business.industry Retrospective cohort study Middle Aged Evoked Potentials Motor Surgery Spinal Fusion Somatosensory evoked potential Spinal fusion Female Technique Assessment Neurology (clinical) business 030217 neurology & neurosurgery Intraoperative neurophysiological monitoring |
| Zdroj: | Oper Neurosurg (Hagerstown) |
| ISSN: | 2332-4260 2332-4252 |
| Popis: | Background Despite the extensive use of intraoperative neurophysiological monitoring (IONM) in spinal procedures, there is no standard guideline for what types of IONM tests should be monitored during lumbar procedures with instrumentation. Moreover, the efficacy of IONM during transforaminal lumbar interbody fusion (TLIF) surgery in detecting postoperative neurological deficits has not been well described. Objective To analyze waveform changes from individual IONM tests (somatosensory evoked potentials [SSEP], motor evoked potentials [MEP], and electromyography [EMG]) during TLIF and compare the sensitivity and specificity of these tests in order to determine the best combination to detect postoperative neurological deficits. Methods Two hundred seventy-five consecutive TLIF cases with IONM between 2010 and 2014 were reviewed, and new postoperative sensory and motor deficits were documented. Sensitivity and specificity for each IONM test in detecting postoperative sensory and/or motor deficits were analyzed. Results SSEP and EMG tests were performed on all 275 patients with 66 patients undergoing additional MEP tests. A total of 7 postoperative deficits have been reported: 2 sensory and 5 motor deficits. MEP test had high sensitivity (80.0%) and specificity (100%) in detecting motor deficits. However, SSEP changes failed to detect sensory deficits and EMG test had high false-positive rates for detecting both sensory (100%) and motor deficits (97.3%). Conclusion MEP test should be incorporated in monitoring protocols during spinal procedures that involve instrumentations below vertebral level L1 such as TLIF, as it provides high sensitivity and specificity in detecting postoperative motor deficits. In addition, we propose modifying the standard lower extremity SSEP monitoring protocol to correspond to the vertebral levels being operated on. |
| Databáze: | OpenAIRE |
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