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The Prognostic Value of Intraoperative Neuromonitoring by Combining Somatosensory- and Motor-Evoked Potentials for
Tun Liu1,2, Buhuai Dong1, Huaguang Qi3
1Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, P.R. China.
Study Design:
Retrospective study.
Objective:
To explore a relation between somatosensory- and motor-evoked potential (SEPs, MEPs) and corresponding thoracic cord function for thoracic spinal decompression surgery (TSDS) in patients with neurological deficit.
Summary Of Background Data:
Although SEPs and MEPs monitoring has been developed as an essential technique in spinal surgery. There are limited data on the reliability of using SEPs and MEPs for TSDS and its prognosis.
Methods:
One hundred twenty patients underwent TSDS in our hospital, 91 patients completed the trial. All the patients were divided into three subgroups according to the changes of MEPs and SEPs: neither SEPs nor MEP deteriorated -. Simply MEP deteriorated and both SEPs and MEP deteriorated -. Bispectral (BIS) was used to monitor the depth of sedation, which ranged from 40 to 60 by varying the infusion speed of anesthetics. The pre- and postoperative spinal function was assessed by muscle strength and Japanese Orthopaedic Association (JOA) score at three time points:1) before surgery; 2) immediately after general anesthesia recovery; 3) after 3-month follow-up.
Results:
Sixty-nine cases showed neither SEPs nor MEP deteriorated -, 10 cases showed only MEP deteriorated, and 12 cases showed both SEPs and MEP deteriorated -. The patients in the group where neither SEPs nor MEP deteriorated had the best recovery of the extremity muscle strength, the shortest recovery time (8.10 ± 1.60, P < 0.05), and toe movement time (8.50 ± 1.60, P < 0.05). There is a strong correlation between SEPs variability ratio at T4 time point and JOA recovery ratio (JOA RR) in the 3-month follow-up.
Conclusion:
Combined SEPs and MEPs monitoring are important for TSDS in patients with neurological deficit and it is helpful for evaluating postoperative prognosis. It is more accurate to record SEPs at T4 time point to predict the patients' prognosis.Level of Evidence: 3.
