Roadmap for Motor Evoked Potential (MEP) Monitoring for Patients Undergoing Lumbar and Lumbosacral Spinal Fusion Procedures
| Autor: | W. Bryan Wilent, Julie M Trott, Anthony K. Sestokas |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.diagnostic_test
business.industry Total intravenous anesthesia 05 social sciences Electromyography Evoked Potentials Motor Neurosurgical Procedures Spine 050105 experimental psychology 03 medical and health sciences Medical Laboratory Technology Spinal Fusion 0302 clinical medicine Lumbar Anesthesia Humans Medicine 0501 psychology and cognitive sciences Lumbosacral spinal fusion Neurology (clinical) Evoked potential Spinal Nerve Roots business 030217 neurology & neurosurgery Lumbosacral joint |
| Zdroj: | The Neurodiagnostic Journal. 61:27-36 |
| ISSN: | 2375-8627 2164-6821 |
| DOI: | 10.1080/21646821.2021.1866934 |
| Popis: | MEPs are recommended for patients undergoing lumbar and lumbosacral procedures in which intraoperative neuromonitoring (IONM) is being utilized. While electromyography (EMG) provides critical nerve root proximity information, spontaneous EMG discharges are relatively poor at reliably diagnosing spinal nerve root dysfunction. In contrast, research indicates that MEPs are both sensitive and specific in diagnosing evolving spinal nerve root dysfunction. There is conflicting evidence, however, and it must be emphasized that the value of adding MEPs is only realized when practices and techniques are optimized. The ideal anesthetic plan is an optimized total intravenous anesthetic (TIVA) regimen. Selection of appropriate anesthetics and dosing is important for optimizing baseline response amplitudes and promoting diagnostic confidence in analyzing signal changes. An adaptive set of alert criteria that account for baseline amplitude and morphology fluctuations should guide the determination of significant signal change. The therapeutic impact of accurate diagnostic information depends on the timeliness of diagnosis and intervention. Prior to the start of surgery, a plan to obtain MEPs at least once every 10 minutes during the active part of the procedure and after every significant surgical maneuver should be agreed upon, and the intervention plan should include but not be limited to possible removal of hardware and release of retraction or distractive forces. In summary, MEPs can improve monitoring of at-risk nerve root function, but the accuracy and therapeutic impact of such monitoring depend on perioperative planning and communication that optimize use of this modality. |
| Databáze: | OpenAIRE |
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