The efficacy of somatosensory evoked potentials in evaluating new neurological deficits after spinal thoracic fusion and decompression

View More View Less
  • 1 Departments of Neurological Surgery and
  • 2 Neurology, University of Pittsburgh, Pennsylvania
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Posterior thoracic fusion (PTF) is used as a surgical treatment for a wide range of pathologies. The monitoring of somatosensory evoked potentials (SSEPs) is used to detect and prevent injury during many neurological surgeries. The authors conducted a study to evaluate the efficacy of SSEPs in predicting perioperative lower-extremity (LE) neurological deficits during spinal thoracic fusion surgery.

METHODS

The authors included patients who underwent PTF with SSEP monitoring performed throughout the entire surgery from 2010 to 2015 at the University of Pittsburgh Medical Center (UPMC). The sensitivity, specificity, odds ratio, and receiver operating characteristic curve were calculated to evaluate the diagnostic accuracy of SSEP changes in predicting postoperative deficits. Univariate analysis was completed to determine the impact of age exceeding 65 years, sex, obesity, abnormal baseline testing, surgery type, and neurological deficits on the development of intraoperative changes.

RESULTS

From 2010 to 2015, 771 eligible patients underwent SSEP monitoring during PTF at UPMC. Univariate and linear regression analyses showed that LE SSEP changes significantly predicted LE neurological deficits. Significant changes in LE SSEPs had a sensitivity and specificity of 19% and 96%, respectively, in predicting LE neurological deficits. The diagnostic odds ratio for patients with new LE neurological deficits who had significant changes in LE SSEPs was 5.86 (95% CI 2.74–12.5). However, the results showed that a loss of LE waveforms had a poor predictive value for perioperative LE deficits (diagnostic OR 1.58 [95% CI 0.19–12.83]).

CONCLUSIONS

Patients with new postoperative LE neurological deficits are 5.9 times more likely to have significant changes in LE SSEPs during PTF. Surgeon awareness of an LE SSEP loss may alter surgical strategy and positively impact rates of postoperative LE neurological deficit status. The relatively poor sensitivity of LE SSEP monitoring may indicate a need for multimodal neurophysiological monitoring, including motor evoked potentials, in thoracic fusion surgery.

ABBREVIATIONS IONM = intraoperative neurophysiological monitoring; LE = lower extremity; PTF = posterior thoracic fusion; SSEP = somatosensory evoked potential; TcMEP = transcranial motor evoked potential; UPMC = University of Pittsburgh Medical Center.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Parthasarathy D. Thirumala: University of Pittsburgh, PA. thirumalapd@upmc.edu.

INCLUDE WHEN CITING Published online March 6, 2020; DOI: 10.3171/2019.12.SPINE191157.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Aita I, Hayashi K, Wadano Y, Yabuki T: Posterior movement and enlargement of the spinal cord after cervical laminoplasty. J Bone Joint Surg Br 80:3337, 1998

    • Search Google Scholar
    • Export Citation
  • 2

    Balzer JR, Rose RD, Welch WC, Sclabassi RJ: Simultaneous somatosensory evoked potential and electromyographic recordings during lumbosacral decompression and instrumentation. Neurosurgery 42:13181325, 1998

    • Search Google Scholar
    • Export Citation
  • 3

    Bose B, Sestokas AK, Schwartz DM: Neurophysiological monitoring of spinal cord function during instrumented anterior cervical fusion. Spine J 4:202207, 2004

    • Search Google Scholar
    • Export Citation
  • 4

    Cheh G, Lenke LG, Padberg AM, Kim YJ, Daubs MD, Kuhns C, : Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do? Spine (Phila Pa 1976) 33:10931099, 2008

    • Search Google Scholar
    • Export Citation
  • 5

    Chen ZY, Wong HK, Chan YH: Variability of somatosensory evoked potential monitoring during scoliosis surgery. J Spinal Disord Tech 17:470476, 2004

    • Search Google Scholar
    • Export Citation
  • 6

    Gonzalez AA, Jeyanandarajan D, Hansen C, Zada G, Hsieh PC: Intraoperative neurophysiological monitoring during spine surgery: a review. Neurosurg Focus 27(4):E6, 2009

    • Search Google Scholar
    • Export Citation
  • 7

    Hilibrand AS, Schwartz DM, Sethuraman V, Vaccaro AR, Albert TJ: Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery. J Bone Joint Surg Am 86:12481253, 2004

    • Search Google Scholar
    • Export Citation
  • 8

    Hsu B, Cree AK, Lagopoulos J, Cummine JL: Transcranial motor-evoked potentials combined with response recording through compound muscle action potential as the sole modality of spinal cord monitoring in spinal deformity surgery. Spine (Phila Pa 1976) 33: 11001106, 2008

    • Search Google Scholar
    • Export Citation
  • 9

    Jackson RK: The long-term effects of wide laminectomy for lumbar disc excision. A review of 130 patients. J Bone Joint Surg Br 53:609616, 1971

    • Search Google Scholar
    • Export Citation
  • 10

    Kawaguchi Y, Matsui H, Tsuji H: Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976) 21:941944, 1996

    • Search Google Scholar
    • Export Citation
  • 11

    Kawaguchi Y, Matsui H, Tsuji H: Back muscle injury after posterior lumbar spine surgery. Part 1: Histologic and histochemical analyses in rats. Spine (Phila Pa 1976) 19:25902597, 1994

    • Search Google Scholar
    • Export Citation
  • 12

    Kelleher MO, Tan G, Sarjeant R, Fehlings MG: Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine 8:215221, 2008

    • Search Google Scholar
    • Export Citation
  • 13

    Kim DY, Lee SH, Chung SK, Lee HY: Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976) 30:123129, 2005

    • Search Google Scholar
    • Export Citation
  • 14

    Macnab IC, Cuthbert H, Godfrey CM: The incidence of denervation of the sacrospinales muscles following spinal surgery. Spine (Phila Pa 1976) 2:294298, 1977

    • Search Google Scholar
    • Export Citation
  • 15

    Nuwer MR, Dawson EG, Carlson LG, Kanim L, Sherman J: Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 96:611, 1995

    • Search Google Scholar
    • Export Citation
  • 16

    Owen JH, Padberg AM, Spahr-Holland L, Bridwell KH, Keppler L, Steffee AD: Clinical correlation between degenerative spine disease and dermatomal somatosensory-evoked potentials in humans. Spine (Phila Pa 1976) 16 (6 Suppl):S201S205, 1991

    • Search Google Scholar
    • Export Citation
  • 17

    Thirumala PD, Melachuri SR, Kaur J, Ninaci D, Melachuri MK, Habeych M, : Diagnostic accuracy of somatosensory evoked potentials in evaluating new neurological deficits after posterior cervical fusions. Spine (Phila Pa 1976) 42:490496, 2017

    • Search Google Scholar
    • Export Citation
  • 18

    Thirumala PD, Bodily L, Tint D, Ward WT, Deeney VF, Crammond DJ, : Somatosensory-evoked potential monitoring during instrumented scoliosis corrective procedures: validity revisited. Spine J 14:15721580, 2014

    • Search Google Scholar
    • Export Citation
  • 19

    Thirumala PD, Huang J, Thiagarajan K, Cheng H, Balzer J, Crammond DJ: Diagnostic accuracy of combined multimodality somatosensory evoked potential and transcranial motor evoked potential intraoperative monitoring in patients with idiopathic scoliosis. Spine (Phila Pa 1976) 41:E1177E1184, 2016

    • Search Google Scholar
    • Export Citation
  • 20

    Tsai RY, Yang RS, Nuwer MR, Kanim LE, Delamarter RB, Dawson EG: Intraoperative dermatomal evoked potential monitoring fails to predict outcome from lumbar decompression surgery. Spine (Phila Pa 1976) 22:19701975, 1997

    • Search Google Scholar
    • Export Citation
  • 21

    Tsai TM, Tsai CL, Lin TS, Lin CC, Jou IM: Value of dermatomal somatosensory evoked potentials in detecting acute nerve root injury: an experimental study with special emphasis on stimulus intensity. Spine (Phila Pa 1976) 30:E540E546, 2005

    • Search Google Scholar
    • Export Citation
  • 22

    York DH, Chabot RJ, Gaines RW: Response variability of somatosensory evoked potentials during scoliosis surgery. Spine (Phila Pa 1976) 12:864876, 1987

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 104 104 30
Full Text Views 57 57 29
PDF Downloads 50 50 24
EPUB Downloads 0 0 0