Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis
BackgroundIntraoperative neuromonitoring (IONM) has become an increasingly essential technique in spinal surgery. However, data on the diagnostic value of IONM in predicting impending postoperative neurological deficits (PONDs) for patients who underwent posterior decompression surgery for thoracic...
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| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2022.879435/full |
| _version_ | 1818471128031559680 |
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| author | Tun Liu Liang Yan Huaguang Qi Zhenguo Luo Xuemei Liu Tao Yuan Buhuai Dong Yuanting Zhao Songchuan Zhao Houkun Li Zhian Liu Xucai Wu Fei Wang Wentao Wang Yunfei Huang Gang Wang |
| author_facet | Tun Liu Liang Yan Huaguang Qi Zhenguo Luo Xuemei Liu Tao Yuan Buhuai Dong Yuanting Zhao Songchuan Zhao Houkun Li Zhian Liu Xucai Wu Fei Wang Wentao Wang Yunfei Huang Gang Wang |
| author_sort | Tun Liu |
| collection | DOAJ |
| description | BackgroundIntraoperative neuromonitoring (IONM) has become an increasingly essential technique in spinal surgery. However, data on the diagnostic value of IONM in predicting impending postoperative neurological deficits (PONDs) for patients who underwent posterior decompression surgery for thoracic spinal stenosis (TSS) are limited. Furthermore, patients who are at the highest risk of waveform changes during the surgery remain unknown. Our purpose was to (1) assess the diagnostic accuracy of IONM by combining somatosensory-evoked potential (SSEP) with motor-evoked potential (MEP) in predicting PONDs for patients who underwent the surgery and (2) identify the independent risk factors correlated with IONM changes in our study population.MethodsA total of 326 consecutive patients who underwent the surgery were identified and analyzed. We collected the following data: (1) demographic and clinical data; (2) IONM data; and (3) outcome data such as details of PONDs, and recovery status (complete, partial, or no recovery) at the 12-month follow-up visit.ResultsIn total, 27 patients developed PONDs. However, 15, 6, and 6 patients achieved complete recovery, partial recovery, and no recovery, respectively, at the 12-month follow-up. SSEP or MEP change monitoring yielded better diagnostic efficacy in predicting PONDs as indicated by the increased sensitivity (96.30%) and area under the receiver operating characteristic (ROC) curve (AUC) value (0.91). Only one neurological deficit occurred without waveform changes. On multiple logistic regression analysis, the independent risk factors associated with waveform changes were as follows: preoperative moderate or severe neurological deficits (p = 0.002), operating in the upper- or middle-thoracic spinal level (p = 0.003), estimated blood loss (EBL) ≥ 400 ml (p < 0.001), duration of symptoms ≥ 3 months (p < 0.001), and impairment of gait (p = 0.001).ConclusionSomatosensory-evoked potential or MEP change is a highly sensitive and moderately specific indicator for predicting PONDs in posterior decompression surgery for TSS. The independent risks for IONM change were as follows: operated in upper- or middle-thoracic spinal level, presented with gait impairment, had massive blood loss, moderate or severe neurological deficits preoperatively, and had a longer duration of symptoms.Clinical Trial Registration[http://www.chictr.org.cn]; identifier [ChiCTR 200003 2155]. |
| first_indexed | 2024-04-13T21:47:33Z |
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| id | doaj.art-d11f13e4e54d4430b87ea4896eee8d1e |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-04-13T21:47:33Z |
| publishDate | 2022-06-01 |
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| series | Frontiers in Neuroscience |
| spelling | doaj.art-d11f13e4e54d4430b87ea4896eee8d1e2022-12-22T02:28:32ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2022-06-011610.3389/fnins.2022.879435879435Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal StenosisTun Liu0Liang Yan1Huaguang Qi2Zhenguo Luo3Xuemei Liu4Tao Yuan5Buhuai Dong6Yuanting Zhao7Songchuan Zhao8Houkun Li9Zhian Liu10Xucai Wu11Fei Wang12Wentao Wang13Yunfei Huang14Gang Wang15Department of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Functional Inspection Section, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Functional Inspection Section, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Functional Inspection Section, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaThe Key Laboratory of Biomedical Information Engineering, Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, ChinaDepartment of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaInstitute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaDepartment of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, ChinaThe Key Laboratory of Biomedical Information Engineering, Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, ChinaBackgroundIntraoperative neuromonitoring (IONM) has become an increasingly essential technique in spinal surgery. However, data on the diagnostic value of IONM in predicting impending postoperative neurological deficits (PONDs) for patients who underwent posterior decompression surgery for thoracic spinal stenosis (TSS) are limited. Furthermore, patients who are at the highest risk of waveform changes during the surgery remain unknown. Our purpose was to (1) assess the diagnostic accuracy of IONM by combining somatosensory-evoked potential (SSEP) with motor-evoked potential (MEP) in predicting PONDs for patients who underwent the surgery and (2) identify the independent risk factors correlated with IONM changes in our study population.MethodsA total of 326 consecutive patients who underwent the surgery were identified and analyzed. We collected the following data: (1) demographic and clinical data; (2) IONM data; and (3) outcome data such as details of PONDs, and recovery status (complete, partial, or no recovery) at the 12-month follow-up visit.ResultsIn total, 27 patients developed PONDs. However, 15, 6, and 6 patients achieved complete recovery, partial recovery, and no recovery, respectively, at the 12-month follow-up. SSEP or MEP change monitoring yielded better diagnostic efficacy in predicting PONDs as indicated by the increased sensitivity (96.30%) and area under the receiver operating characteristic (ROC) curve (AUC) value (0.91). Only one neurological deficit occurred without waveform changes. On multiple logistic regression analysis, the independent risk factors associated with waveform changes were as follows: preoperative moderate or severe neurological deficits (p = 0.002), operating in the upper- or middle-thoracic spinal level (p = 0.003), estimated blood loss (EBL) ≥ 400 ml (p < 0.001), duration of symptoms ≥ 3 months (p < 0.001), and impairment of gait (p = 0.001).ConclusionSomatosensory-evoked potential or MEP change is a highly sensitive and moderately specific indicator for predicting PONDs in posterior decompression surgery for TSS. The independent risks for IONM change were as follows: operated in upper- or middle-thoracic spinal level, presented with gait impairment, had massive blood loss, moderate or severe neurological deficits preoperatively, and had a longer duration of symptoms.Clinical Trial Registration[http://www.chictr.org.cn]; identifier [ChiCTR 200003 2155].https://www.frontiersin.org/articles/10.3389/fnins.2022.879435/fullsomatosensory-evoked potentialmotor-evoked potentialpostoperative neurological deficitsthoracic spinal stenosisintraoperative neuromonitoring |
| spellingShingle | Tun Liu Liang Yan Huaguang Qi Zhenguo Luo Xuemei Liu Tao Yuan Buhuai Dong Yuanting Zhao Songchuan Zhao Houkun Li Zhian Liu Xucai Wu Fei Wang Wentao Wang Yunfei Huang Gang Wang Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis Frontiers in Neuroscience somatosensory-evoked potential motor-evoked potential postoperative neurological deficits thoracic spinal stenosis intraoperative neuromonitoring |
| title | Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis |
| title_full | Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis |
| title_fullStr | Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis |
| title_full_unstemmed | Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis |
| title_short | Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis |
| title_sort | diagnostic value of multimodal intraoperative neuromonitoring by combining somatosensory with motor evoked potential in posterior decompression surgery for thoracic spinal stenosis |
| topic | somatosensory-evoked potential motor-evoked potential postoperative neurological deficits thoracic spinal stenosis intraoperative neuromonitoring |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2022.879435/full |
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