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What Is the Best Multimodality Combination for Intraoperative Spinal Cord Monitoring of Motor Function? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.

Ito Z, Matsuyama Y, Ando M, Kawabata S, Kanchiku T, Kida K, Fujiwara Y, Yamada K, Yamamoto N, Kobayashi S, Saito T, Wada K, Satomi K, Shinomiya K, Tani T - Global Spine J (2015)

Bottom Line: Objective To analyze multimodal intraoperative monitoring (MIOM) for different combinations of methods based on the collected data and determine the best combination.Meanwhile, the sensitivity was as low as 50% with Br-SCEP + Sp-SCEP (i.e., the cases where TcMEP was not included).Conclusions The best multimodality combination for intraoperative spinal cord monitoring is TcMEP + Br-SCEP, which had the highest sensitivity (90%), the lowest false-positive rate (6.1%), and the lowest false-negative rate (0.2%).

View Article: PubMed Central - PubMed

Affiliation: Nagoya University, Nagoya, Aichi Prefecture, Japan.

ABSTRACT
Study Design Surgeon survey. Objective To analyze multimodal intraoperative monitoring (MIOM) for different combinations of methods based on the collected data and determine the best combination. Methods A questionnaire was sent to 72 training institutions to analyze and compile data about monitoring that had been conducted during the preceding 5 years to obtain data on the following: (1) types of monitoring; (2) names and number of diseases; (3) conditions of anesthesia; (4) condition of stimulation, the monitored muscle and its number; (5) complications; and (6) preoperative and postoperative manual muscle testing, presence of dysesthesia, and the duration of postoperative motor deficit. Sensitivity and specificity, false-positive rates, and false-negative rates were examined for each type of monitoring, along with the relationship between each type of monitoring and the period of postoperative motor deficit. Results Comparison of the various combinations showed transcranial electrical stimulation motor evoked potential (TcMEP) + cord evoked potential after stimulation to the brain (Br-SCEP) combination had the highest sensitivity (90%). The TcMEP + somatosensory evoked potential (SSEP) and TcMEP + spinal cord evoked potential after stimulation to the spinal cord (Sp-SCEP) combinations each had a sensitivity of 80%, exhibiting little difference between their sensitivity and that obtained when TcMEP alone was used. Meanwhile, the sensitivity was as low as 50% with Br-SCEP + Sp-SCEP (i.e., the cases where TcMEP was not included). Conclusions The best multimodality combination for intraoperative spinal cord monitoring is TcMEP + Br-SCEP, which had the highest sensitivity (90%), the lowest false-positive rate (6.1%), and the lowest false-negative rate (0.2%).

No MeSH data available.


Related in: MedlinePlus

Flowchart of the subjects of this study showing mean tests per patient and mean recording numbers. Abbreviations: Br-SCEP, cord evoked potential after stimulation to the brain; MIOM, multimodal intraoperative monitoring; SIOM, single-modality monitoring; Sp-SCEP, spinal cord evoked potential after stimulation to the spinal cord; SSEP, somatosensory evoked potential; Tc-MEP, transcranial electrical stimulation motor evoked potential.
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FI1400113-1: Flowchart of the subjects of this study showing mean tests per patient and mean recording numbers. Abbreviations: Br-SCEP, cord evoked potential after stimulation to the brain; MIOM, multimodal intraoperative monitoring; SIOM, single-modality monitoring; Sp-SCEP, spinal cord evoked potential after stimulation to the spinal cord; SSEP, somatosensory evoked potential; Tc-MEP, transcranial electrical stimulation motor evoked potential.

Mentions: Of the 7,158 cases, 3,028 met these criteria. In particular, 1,396 cases of single-modality monitoring (SIOM; 17 institutions) and 1,632 cases of MIOM (13 institutions) were selected as the subjects of this study (Fig. 1).


What Is the Best Multimodality Combination for Intraoperative Spinal Cord Monitoring of Motor Function? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.

Ito Z, Matsuyama Y, Ando M, Kawabata S, Kanchiku T, Kida K, Fujiwara Y, Yamada K, Yamamoto N, Kobayashi S, Saito T, Wada K, Satomi K, Shinomiya K, Tani T - Global Spine J (2015)

Flowchart of the subjects of this study showing mean tests per patient and mean recording numbers. Abbreviations: Br-SCEP, cord evoked potential after stimulation to the brain; MIOM, multimodal intraoperative monitoring; SIOM, single-modality monitoring; Sp-SCEP, spinal cord evoked potential after stimulation to the spinal cord; SSEP, somatosensory evoked potential; Tc-MEP, transcranial electrical stimulation motor evoked potential.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4836939&req=5

FI1400113-1: Flowchart of the subjects of this study showing mean tests per patient and mean recording numbers. Abbreviations: Br-SCEP, cord evoked potential after stimulation to the brain; MIOM, multimodal intraoperative monitoring; SIOM, single-modality monitoring; Sp-SCEP, spinal cord evoked potential after stimulation to the spinal cord; SSEP, somatosensory evoked potential; Tc-MEP, transcranial electrical stimulation motor evoked potential.
Mentions: Of the 7,158 cases, 3,028 met these criteria. In particular, 1,396 cases of single-modality monitoring (SIOM; 17 institutions) and 1,632 cases of MIOM (13 institutions) were selected as the subjects of this study (Fig. 1).

Bottom Line: Objective To analyze multimodal intraoperative monitoring (MIOM) for different combinations of methods based on the collected data and determine the best combination.Meanwhile, the sensitivity was as low as 50% with Br-SCEP + Sp-SCEP (i.e., the cases where TcMEP was not included).Conclusions The best multimodality combination for intraoperative spinal cord monitoring is TcMEP + Br-SCEP, which had the highest sensitivity (90%), the lowest false-positive rate (6.1%), and the lowest false-negative rate (0.2%).

View Article: PubMed Central - PubMed

Affiliation: Nagoya University, Nagoya, Aichi Prefecture, Japan.

ABSTRACT
Study Design Surgeon survey. Objective To analyze multimodal intraoperative monitoring (MIOM) for different combinations of methods based on the collected data and determine the best combination. Methods A questionnaire was sent to 72 training institutions to analyze and compile data about monitoring that had been conducted during the preceding 5 years to obtain data on the following: (1) types of monitoring; (2) names and number of diseases; (3) conditions of anesthesia; (4) condition of stimulation, the monitored muscle and its number; (5) complications; and (6) preoperative and postoperative manual muscle testing, presence of dysesthesia, and the duration of postoperative motor deficit. Sensitivity and specificity, false-positive rates, and false-negative rates were examined for each type of monitoring, along with the relationship between each type of monitoring and the period of postoperative motor deficit. Results Comparison of the various combinations showed transcranial electrical stimulation motor evoked potential (TcMEP) + cord evoked potential after stimulation to the brain (Br-SCEP) combination had the highest sensitivity (90%). The TcMEP + somatosensory evoked potential (SSEP) and TcMEP + spinal cord evoked potential after stimulation to the spinal cord (Sp-SCEP) combinations each had a sensitivity of 80%, exhibiting little difference between their sensitivity and that obtained when TcMEP alone was used. Meanwhile, the sensitivity was as low as 50% with Br-SCEP + Sp-SCEP (i.e., the cases where TcMEP was not included). Conclusions The best multimodality combination for intraoperative spinal cord monitoring is TcMEP + Br-SCEP, which had the highest sensitivity (90%), the lowest false-positive rate (6.1%), and the lowest false-negative rate (0.2%).

No MeSH data available.


Related in: MedlinePlus