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Transcranial Motor Evoked Potential Monitoring for the Detection of Nerve Root Injury during Adult Spinal Deformity Surgery.

Research paper by Hiroki H Ushirozako, Go G Yoshida, Sho S Kobayashi, Tomohiko T Hasegawa, Yu Y Yamato, Tatsuya T Yasuda, Tomohiro T Banno, Hideyuki H Arima, Shin S Oe, Yuki Y Mihara, Daisuke D Togawa, Yukihiro Y Matsuyama

Indexed on: 01 Aug '18Published on: 01 Aug '18Published in: Asian spine journal



Abstract

Retrospective study. We aimed to determine the utility of transcranial motor evoked potential (TcMEP) monitoring for the detection of intraoperative nerve root injury. Intraoperative neuromonitoring is important for the prediction of neurological injuries or postoperative paralysis. Nerve root injury can develop as a complication of adult spinal deformity (ASD) surgery. We analyzed 295 patients who underwent ASD surgery using multi-channel TcMEP monitoring between 2010 and 2016 (58 men, 237 women; median age, 68 years; follow-up period ≥1 year). We defined the alarm point as a TcMEP amplitude <30% of that at baseline, and nerve root injury as meeting the focal TcMEP alerts shortly following surgical procedures with the presence of postoperative motor deficits in the selected muscles. Patients were classified into two groups, as those with nerve root injury and those with true-negatives. Seven patients (2.4%) exhibited neurological events related to nerve root injury, comprising six true-positive and one falsenegative cases. TcMEP monitoring from multiple myotomes was effective in detecting nerve root injury. Compared to the 248 truenegative cases, the seven cases of nerve root injury were associated with significantly different preoperative pelvic tilt (PT) values, sacral slope values, and degree of change in PT. The cutoff for the degree of change in PT for predicting nerve root injury, with the best sensitivity and specificity, was 17.5°. Multivariate logistic analyses revealed that a change of >17.5° in PT (odds ratio, 17.5; 95% confidence interval, 1.994-153.560; p =0.010) was independently associated with intraoperative nerve root injury. Multi-channel TcMEP monitoring may be useful for detecting nerve root injuries. A change in PT of >17.5° may be a significant risk factor for neurological events related to intraoperative nerve root injury.