Kohshi Hattori1, Kenji Yoshitani2, Shinya Kato1, Masahiko Kawaguchi3, Mikito Kawamata4, Manabu Kakinohana5, Yoshitsugu Yamada6, Michiaki Yamakage7, Kimitoshi Nishiwaki8, Shunsuke Izumi5, Yusuke Yoshikawa7, Yoshiteru Mori6, Kazuko Hasegawa8, Yoshihiko Onishi1. 1. National Cerebral and Cardiovascular Center, Osaka, Japan. 2. National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: ykenji@ncvc.go.jp. 3. Department of Anesthesiology, Nara Medical University, Nara, Japan. 4. Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Nagano, Japan. 5. Department of Anesthesiology, University of the Ryukyus, Okinawa, Japan. 6. Department of Anesthesiology and Pain Relief Center, The University of Tokyo, Tokyo, Japan. 7. Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan. 8. Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Abstract
OBJECTIVES: The authors investigated the association between intraoperative motor-evoked potential (MEP) changes and the severity of spinal cord infarction diagnosed with magnetic resonance imaging (MRI) to clarify the discrepancy between them, which was observed in patients with postoperative motor deficits after thoracic and thoracoabdominal aortic surgery. DESIGN: A multicenter retrospective study. SETTING: Motor-evoked potential <25% of control values was deemed positive for spinal cord ischemia. The severity of spinal cord infarction was categorized into grades A to D based on previous studies using the most severe axial MRI slices. The associations between MRI grade, MEP changes, and motor deficits were examined using logistic regression. PARTICIPANTS: Twenty-three of 1,245 patients (from 1999 to 2013, at 12 hospitals in Japan) were extracted from medical records of patients who underwent thoracic and thoracoabdominal aortic repair, with intraoperative MEP examinations and postoperative spinal MRI. INTERVENTIONS: No intervention (observational study). MEASUREMENTS AND MAIN RESULTS: Motor-evoked potential <25% of control value was associated significantly with motor deficits at discharge (adjusted odds ratio [OR], 130.0; p = 0.041), but not with severity of spinal cord infarction (adjusted OR, 0.917; p = 0.931). Motor deficit at discharge was associated with severe spinal cord infarction (adjusted OR, 4.83; p = 0.043), MEP <25% (adjusted OR, 13.95; p = 0.031), and combined deficits (motor and sensory, motor and bowel or bladder, or sensory and bowel or bladder deficits; adjusted OR, 31.03; p = 0.072) in stepwise logistic regression analysis. CONCLUSION: Motor-evoked potential <25% was associated significantly with motor deficits at discharge, but not with the severity of spinal cord infarction.
OBJECTIVES: The authors investigated the association between intraoperative motor-evoked potential (MEP) changes and the severity of spinal cord infarction diagnosed with magnetic resonance imaging (MRI) to clarify the discrepancy between them, which was observed in patients with postoperative motor deficits after thoracic and thoracoabdominal aortic surgery. DESIGN: A multicenter retrospective study. SETTING: Motor-evoked potential <25% of control values was deemed positive for spinal cord ischemia. The severity of spinal cord infarction was categorized into grades A to D based on previous studies using the most severe axial MRI slices. The associations between MRI grade, MEP changes, and motor deficits were examined using logistic regression. PARTICIPANTS: Twenty-three of 1,245 patients (from 1999 to 2013, at 12 hospitals in Japan) were extracted from medical records of patients who underwent thoracic and thoracoabdominal aortic repair, with intraoperative MEP examinations and postoperative spinal MRI. INTERVENTIONS: No intervention (observational study). MEASUREMENTS AND MAIN RESULTS: Motor-evoked potential <25% of control value was associated significantly with motor deficits at discharge (adjusted odds ratio [OR], 130.0; p = 0.041), but not with severity of spinal cord infarction (adjusted OR, 0.917; p = 0.931). Motor deficit at discharge was associated with severe spinal cord infarction (adjusted OR, 4.83; p = 0.043), MEP <25% (adjusted OR, 13.95; p = 0.031), and combined deficits (motor and sensory, motor and bowel or bladder, or sensory and bowel or bladder deficits; adjusted OR, 31.03; p = 0.072) in stepwise logistic regression analysis. CONCLUSION: Motor-evoked potential <25% was associated significantly with motor deficits at discharge, but not with the severity of spinal cord infarction.
Authors: Fabian I Kerkhof; Jan van Schaik; Richard A Massaad; Catharina S P van Rijswijk; Martijn R Tannemaat Journal: Clin Neurophysiol Pract Date: 2020-12-11
Authors: Dougho Park; Byung Hee Kim; Sang Eok Lee; Ji Kang Park; Jae Man Cho; Heum Dai Kwon; Su Yun Lee Journal: Front Neurol Date: 2020-10-27 Impact factor: 4.003