Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period
Background: Presence of preoperative motor deficits in patients poses a distinct challenge in monitoring the integrity of corticospinal tracts during spinal surgeries. The inconsistency of the motor-evoked potentials is such patients, limits its clinical utility. D-wave is a robust but less utilized...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2021;volume=12;issue=1;spage=26;epage=32;aulast=Bir |
| _version_ | 1818964974351941632 |
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| author | Megha Bir Uditi Gupta Ashok Kumar Jaryal Akanksha Singh Ritesh Netam Shashank Sharad Kale Sarat P Chandra Manmohan Singh Girija Prasad Rath |
| author_facet | Megha Bir Uditi Gupta Ashok Kumar Jaryal Akanksha Singh Ritesh Netam Shashank Sharad Kale Sarat P Chandra Manmohan Singh Girija Prasad Rath |
| author_sort | Megha Bir |
| collection | DOAJ |
| description | Background: Presence of preoperative motor deficits in patients poses a distinct challenge in monitoring the integrity of corticospinal tracts during spinal surgeries. The inconsistency of the motor-evoked potentials is such patients, limits its clinical utility. D-wave is a robust but less utilized technique for corticospinal tract monitoring. The comparative clinical value of these two techniques has not been evaluated in the patients with preoperative deficits.
Objectives: The objective of the study was to compare the predictive utility of myogenic Motor Evoked Potentials (m-MEP) and D-wave in terms of recordability and their sensitivity and specificity in predicting transient and permanent new motor deficits.
Materials and Methods: Thirty-one patients with preoperative motor deficit scheduled to undergo spinal surgery were included in the study. Intraoperative m-MEP and D-wave changes were identified and correlated with postoperative neurology in the immediate postoperative period and at the time of discharge.
Results: The mean preoperative motor power of the patient pool in left and right lower limb was 2.97 ± 1.56 and 3.32 ± 1.49, respectively. The recordability of m-MEPs and D-wave was observed to be 79.4% and 100%, respectively. The m-MEP predicted the motor deterioration in immediate postoperative period with 100% sensitivity and 80% specificity, while D-wave had 14% sensitivity and 100% specificity. At the time of discharge, m-MEPs' specificity reduced to 61%, while D-wave demonstrated 100% specificity.
Conclusions: D-wave has a better recordability than m-MEPs in neurologically compromised patients. D-wave predicts development of long-term deficits with 100% specificity, while m-MEPs have a high sensitivity for transient neurological deficit. A combination of D-wave and m-MEP is recommended for monitoring the integrity of the corticospinal tract in patients with preoperative motor deficits. |
| first_indexed | 2024-12-20T13:09:38Z |
| format | Article |
| id | doaj.art-2c01d73372984088a7de0cfa8a01893b |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-12-20T13:09:38Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-2c01d73372984088a7de0cfa8a01893b2022-12-21T19:39:41ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372021-01-01121263210.4103/jcvjs.JCVJS_76_20Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative periodMegha BirUditi GuptaAshok Kumar JaryalAkanksha SinghRitesh NetamShashank Sharad KaleSarat P ChandraManmohan SinghGirija Prasad RathBackground: Presence of preoperative motor deficits in patients poses a distinct challenge in monitoring the integrity of corticospinal tracts during spinal surgeries. The inconsistency of the motor-evoked potentials is such patients, limits its clinical utility. D-wave is a robust but less utilized technique for corticospinal tract monitoring. The comparative clinical value of these two techniques has not been evaluated in the patients with preoperative deficits. Objectives: The objective of the study was to compare the predictive utility of myogenic Motor Evoked Potentials (m-MEP) and D-wave in terms of recordability and their sensitivity and specificity in predicting transient and permanent new motor deficits. Materials and Methods: Thirty-one patients with preoperative motor deficit scheduled to undergo spinal surgery were included in the study. Intraoperative m-MEP and D-wave changes were identified and correlated with postoperative neurology in the immediate postoperative period and at the time of discharge. Results: The mean preoperative motor power of the patient pool in left and right lower limb was 2.97 ± 1.56 and 3.32 ± 1.49, respectively. The recordability of m-MEPs and D-wave was observed to be 79.4% and 100%, respectively. The m-MEP predicted the motor deterioration in immediate postoperative period with 100% sensitivity and 80% specificity, while D-wave had 14% sensitivity and 100% specificity. At the time of discharge, m-MEPs' specificity reduced to 61%, while D-wave demonstrated 100% specificity. Conclusions: D-wave has a better recordability than m-MEPs in neurologically compromised patients. D-wave predicts development of long-term deficits with 100% specificity, while m-MEPs have a high sensitivity for transient neurological deficit. A combination of D-wave and m-MEP is recommended for monitoring the integrity of the corticospinal tract in patients with preoperative motor deficits.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2021;volume=12;issue=1;spage=26;epage=32;aulast=Bircorticospinal tract monitoringd-waveepidural potentialsintraoperative neurophysiological monitoringmotor evoked potentials |
| spellingShingle | Megha Bir Uditi Gupta Ashok Kumar Jaryal Akanksha Singh Ritesh Netam Shashank Sharad Kale Sarat P Chandra Manmohan Singh Girija Prasad Rath Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period Journal of Craniovertebral Junction and Spine corticospinal tract monitoring d-wave epidural potentials intraoperative neurophysiological monitoring motor evoked potentials |
| title | Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period |
| title_full | Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period |
| title_fullStr | Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period |
| title_full_unstemmed | Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period |
| title_short | Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period |
| title_sort | predictive value of intraoperative d wave and m mep neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period |
| topic | corticospinal tract monitoring d-wave epidural potentials intraoperative neurophysiological monitoring motor evoked potentials |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2021;volume=12;issue=1;spage=26;epage=32;aulast=Bir |
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