Jeffrey Peck1, Kiley Poppino2, Steven Sparagana3, Patricia Rampy3, Spencer Freeman3, Chan-Hee Jo4, Daniel Sucato5. 1. Division of Pediatric Orthopaedic Surgery, Children's National Hospital, Washington, DC, 20010, USA. 2. Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn Street, Dallas, TX, 75219, USA. 3. Department of Neurology and Rehabilitation Medicine, Texas Scottish Rite Hospital, University of Texas Southwestern Medical Center, Dallas, TX, 75219, USA. 4. Research Department, Texas Scottish Rite Hospital, Dallas, TX, 75219, USA. 5. Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn Street, Dallas, TX, 75219, USA. Dan.Sucato@tsrh.org.
Abstract
PURPOSE: Intraoperative neuromonitoring (IONM) has historically been difficult to obtain in patients with Charcot-Marie-Tooth (CMT) disease. Transcranial motor-evoked potentials (TcMEPs) have been found to be safe and effective for other spinal deformity patients. Our objective was to determine the effectiveness of TcMEP monitoring in patients with CMT. METHODS: An IRB-approved, retrospective review of CMT patients undergoing spinal deformity surgery assessing TcMEP, somatosensory-evoked potential (SSEP), and neurogenic motor evoked potential (NMEP) IONM was performed. A 2:1 matched cohort control group of idiopathic spinal deformity patients was used. A waveform grading system was applied to review baseline TcMEP reliability and quality, which was validated via intraclass correlation coefficient amongst five raters. RESULTS: Twenty-three CMT patients (26 surgical cases) were identified. The use of TcMEP improved the ability to obtain baseline IONM when compared to SSEP (83% vs. 20%; p < 0.001) and NMEP (83% vs. 18%; p = 0.003). Baseline monitoring was obtained less often for CMT patients using SSEP (20% vs. 100%; p < 0.001) and TcMEP (83% vs. 100%; p = 0.111) compared to idiopathic patients. Sweep length (time from stimulation waveform evaluation) and maximum stimulation voltage were higher in the CMT group (289 ms vs. 111 ms p = 0.007 and 740 V vs. 345 V p = 0.089, respectively). CONCLUSION: TcMEP monitoring significantly improves the ability to provide IONM for CMT patients undergoing spinal deformity surgery. Utilizing longer sweep lengths enhances the ability to attain baseline TcMEP readings, allowing surgeons to more safely proceed with surgery for these complex patients. LEVEL OF EVIDENCE: Therapeutic-Level III.
PURPOSE: Intraoperative neuromonitoring (IONM) has historically been difficult to obtain in patients with Charcot-Marie-Tooth (CMT) disease. Transcranial motor-evoked potentials (TcMEPs) have been found to be safe and effective for other spinal deformity patients. Our objective was to determine the effectiveness of TcMEP monitoring in patients with CMT. METHODS: An IRB-approved, retrospective review of CMT patients undergoing spinal deformity surgery assessing TcMEP, somatosensory-evoked potential (SSEP), and neurogenic motor evoked potential (NMEP) IONM was performed. A 2:1 matched cohort control group of idiopathic spinal deformity patients was used. A waveform grading system was applied to review baseline TcMEP reliability and quality, which was validated via intraclass correlation coefficient amongst five raters. RESULTS: Twenty-three CMT patients (26 surgical cases) were identified. The use of TcMEP improved the ability to obtain baseline IONM when compared to SSEP (83% vs. 20%; p < 0.001) and NMEP (83% vs. 18%; p = 0.003). Baseline monitoring was obtained less often for CMT patients using SSEP (20% vs. 100%; p < 0.001) and TcMEP (83% vs. 100%; p = 0.111) compared to idiopathic patients. Sweep length (time from stimulation waveform evaluation) and maximum stimulation voltage were higher in the CMT group (289 ms vs. 111 ms p = 0.007 and 740 V vs. 345 V p = 0.089, respectively). CONCLUSION: TcMEP monitoring significantly improves the ability to provide IONM for CMT patients undergoing spinal deformity surgery. Utilizing longer sweep lengths enhances the ability to attain baseline TcMEP readings, allowing surgeons to more safely proceed with surgery for these complex patients. LEVEL OF EVIDENCE: Therapeutic-Level III.
Authors: M R Nuwer; R G Emerson; G Galloway; A D Legatt; J Lopez; R Minahan; T Yamada; D S Goodin; C Armon; V Chaudhry; G S Gronseth; C L Harden Journal: Neurology Date: 2012-02-21 Impact factor: 9.910
Authors: Ron El-Hawary; Daniel J Sucato; Steven Sparagana; Anna McClung; Elizabeth Van Allen; Patricia Rampy Journal: Spine (Phila Pa 1976) Date: 2006-09-01 Impact factor: 3.468
Authors: F Pastorelli; M Di Silvestre; R Plasmati; R Michelucci; T Greggi; A Morigi; M R Bacchin; S Bonarelli; A Cioni; F Vommaro; N Fini; F Lolli; P Parisini Journal: Eur Spine J Date: 2011-03-18 Impact factor: 3.134
Authors: Danielle D Langeloo; Arjan Lelivelt; H Louis Journée; Robert Slappendel; Marinus de Kleuver Journal: Spine (Phila Pa 1976) Date: 2003-05-15 Impact factor: 3.468