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Intraoperative Neuromonitoring Auxiliary Significance of DNEP for MEP-positive Event During Severe Spinal Deformity
Jian Chen1, Yao-Long Deng1, Wen-Yuan Sui1
1Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai.
Study Design:
This was a retrospective analysis.
Objective:
The objective of this study was to assess the intraoperative neuromonitoring auxiliary significance of descending neurogenic-evoked potential (DNEP) for motor-evoked potential (MEP) during severe spinal deformity surgery when MEP-positive event occurs.
Summary Of Background Data:
MEP detection is the most widely applied neurological monitoring technique in spinal deformity surgery. MEP is quite vulnerable to anesthesia, blood pressure, and other intraoperative factors, leading to a high false-positive rate of MEP (3.2%-45.0%), which has greatly interfered with the surgical process. At present, the widely used "presence-or-absence" alarm criteria of MEP is not enough to solve the problem of false positive of MEP.
Methods:
A total of 205 cases undergoing severe spinal deformity correction were retrospectively studied. Overall, 74 MEP-positive cases were classified as 2 subgroups: DNEP (+) and DNEP (-) groups. The MEP recovery, wake-up test, and Frankle grade were used to assess the neurological functions. The perioperative and long-term neurological outcomes were assessed.
Results:
There were significant differences in preoperative scoliosis angle and kyphosis angle between DNEP (-) and DNEP (+) groups. Patients in DNEP (-) group showed more MEP improvement (81.5%), compared with the DNEP (+) group (53.2%). The Wake-up test showed 59.3% motor function deficit cases in DNEP (-) group, which was lower than the 87.2% in DNEP (+) group. More patients in DNEP (-) group had normal nerve function (Frankel level E) than those in DNEP (+) group immediately after surgery, as well as at follow-up.
Conclusions:
MEP-positive cases with intraoperative DNEP (-) showed superior prognosis after severe spinal deformity surgery. Intraoperative DNEP could be regarded as an important quantitative tool to assist MEP to monitor neurological injury and can serve as a temporary substitution monitoring technique after MEP is lost.
Insights
Descending neurogenic-evoked potential (DNEP) can help interpret motor-evoked potential (MEP) signals during spinal surgery. MEP-positive cases with negative DNEP (DNEP-) indicate better outcomes, suggesting DNEP as a valuable tool for monitoring neurological injury.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Neuromonitoring
Background:
- Motor-evoked potential (MEP) is crucial for spinal deformity surgery but has a high false-positive rate.
- Current MEP monitoring lacks sufficient accuracy due to intraoperative factors.
- Advanced techniques are needed to improve the reliability of MEP in spinal surgery.
Purpose of the Study:
- To evaluate the auxiliary role of descending neurogenic-evoked potential (DNEP) in interpreting motor-evoked potential (MEP) signals.
- To assess the significance of DNEP in severe spinal deformity surgery when MEP events occur.
- To determine if DNEP can improve the accuracy of neuromonitoring during complex spinal procedures.
Main Methods:
- Retrospective analysis of 205 patients undergoing severe spinal deformity correction.
- Classification of 74 MEP-positive cases into DNEP (+) and DNEP (-) subgroups.
- Assessment of neurological function using MEP recovery, wake-up tests, and Frankel grading.
Main Results:
- Significant differences in spinal deformity angles were observed between DNEP (-) and DNEP (+) groups.
- The DNEP (-) group exhibited higher MEP improvement (81.5%) compared to the DNEP (+) group (53.2%).
- The DNEP (-) group showed lower motor function deficits (59.3%) and better neurological recovery (Frankel E).
Conclusions:
- MEP-positive cases with intraoperative DNEP (-) demonstrate superior outcomes in severe spinal deformity surgery.
- Intraoperative DNEP serves as a valuable quantitative tool to assist MEP in monitoring neurological injury.
- DNEP can function as a temporary substitute monitoring technique when MEP signals are lost.
