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 a...

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Published in:The spine journal 2014-07, Vol.14 (7), p.1214-1220
Main Authors: Azabou, Eric, MD, Manel, Véronique, MD, Abelin-Genevois, Kariman, MD, Andre-Obadia, Nathalie, MD, Cunin, Vincent, MD, Garin, Christophe, MD, Kohler, Remi, MD, PhD, Berard, Jérôme, MD, PhD, Ulkatan, Sedat, MD, PhD
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Cohort Studies
Decision tree
Evoked Potentials, Motor - physiology
Evoked Potentials, Somatosensory - physiology
Feasibility
Female
Human health and pathology
Humans
Intraoperative monitoring
Life Sciences
Male
Monitoring, Intraoperative - methods
Motor evoked potentials
Orthopedics
Planning
Preoperative procedures
Scoliosis
Scoliosis - physiopathology
Scoliosis - surgery
Sensitivity and Specificity
Somatosensory evoked potentials
Spinal Cord - physiopathology
Surgery
Tissues and Organs
Transcranial Direct Current Stimulation
Young Adult
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Summary: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.
ISSN:1529-9430
1878-1632
DOI:10.1016/j.spinee.2013.08.017