Shujie Wang1, Yang Yang1, Qiyi Li1, Jie Zhu2, Jianxiong Shen1, Ye Tian1, Yong Hu3, Zhi Li4, Wei Xu5, Yang Jiao6, Rui Cao7, Jianguo Zhang8. 1. Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China. 2. Brain Center, Logistics Academy Affiliated Hospital of Chinese People's Armed Police Force, Tianjin, China. 3. Department of Orthopedics and Traumatology, The University of Hong Kong, Hong Kong, China. 4. Department of Orthopedics, Shenyang Medical College Affiliated Center Hospital, Shenyang, Liaoning, China. 5. Operating Room, Peking Union Medical College Hospital, Beijing, China. 6. Department of Spine Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China. 7. Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China. 8. Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China. Electronic address: jgzhang_pumch@yahoo.com.
Abstract
BACKGROUND: Intraoperative neurologic monitoring (IONM) has become an essential component for decreasing the incidence of spinal cord injury during spine surgeries. Many high-risk surgical maneuvers that result in significant IONM alerts have not been reported systematically. Our objective was to thoroughly summarize some common high-risk surgical points associated with IONM alerts in various spine surgeries. METHODS: Between November 2010 and April 2017, 62 patients with true-positive IONM alerts from 3139 spine surgeries were enrolled. Transcranial motor evoked potentials, somatosensory evoked potentials, and free-run electromyography were used for IONM. All 62 patients were identified as true-positive IONM cases. RESULTS: Of 3139 patients, 101 demonstrated significant IONM changes-62 true-positive cases, 14 false-positive cases, and 25 indeterminate IONM results. IONM alerts most often occurred in thoracic screw placement (n = 10, 16.1%), osteotomy (n = 22, 35.5%), correction (n = 19, 30.6%), and spinal cord decompression (n = 11, 17.8%). Appropriate timely measures are indicated in response to IONM alerts during high-risk surgical maneuvers. Ten (10/62, 16.1%) patients showed permanent postoperative neurologic deficits. CONCLUSIONS: IONM alerts are often associated with some specific high-risk surgical maneuvers. Careful and timely observation is crucial.
BACKGROUND: Intraoperative neurologic monitoring (IONM) has become an essential component for decreasing the incidence of spinal cord injury during spine surgeries. Many high-risk surgical maneuvers that result in significant IONM alerts have not been reported systematically. Our objective was to thoroughly summarize some common high-risk surgical points associated with IONM alerts in various spine surgeries. METHODS: Between November 2010 and April 2017, 62 patients with true-positive IONM alerts from 3139 spine surgeries were enrolled. Transcranial motor evoked potentials, somatosensory evoked potentials, and free-run electromyography were used for IONM. All 62 patients were identified as true-positive IONM cases. RESULTS: Of 3139 patients, 101 demonstrated significant IONM changes-62 true-positive cases, 14 false-positive cases, and 25 indeterminate IONM results. IONM alerts most often occurred in thoracic screw placement (n = 10, 16.1%), osteotomy (n = 22, 35.5%), correction (n = 19, 30.6%), and spinal cord decompression (n = 11, 17.8%). Appropriate timely measures are indicated in response to IONM alerts during high-risk surgical maneuvers. Ten (10/62, 16.1%) patients showed permanent postoperative neurologic deficits. CONCLUSIONS: IONM alerts are often associated with some specific high-risk surgical maneuvers. Careful and timely observation is crucial.
Authors: Martin Sutter; Andreas Eggspuehler; Dezsoe Jeszenszky; Frank Kleinstueck; Tamàs F Fekete; Daniel Haschtmann; François Porchet; Jiri Dvorak Journal: Eur Spine J Date: 2018-12-17 Impact factor: 3.134