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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.


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Sensitivity rate for single-modality monitoring group. Abbreviations: n.s., not significant; 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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FI1400113-3: Sensitivity rate for single-modality monitoring group. Abbreviations: n.s., not significant; 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: The SIOM group included 22 cases of postoperative motor deficit, in which 17/884 cases (1.9%) occurred with TcMEP, 3/140 cases (2.1%) with Sp-SCEP, and 2/372 cases (0.5%) with SSEP. The overall sensitivity and specificity in the SIOM group were 72 and 95%, respectively, with a false-positive rate of 5%. Review of each type of monitoring revealed that TcMEP had a significantly higher sensitivity (82%) than Sp-SCEP. The sensitivity was significantly lower in the cases where only Sp-SCEP or SSEP was conducted (SSEP: 50%, Sp-SCEP: 33%; see Fig. 3 and Table 4).


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)

Sensitivity rate for single-modality monitoring group. Abbreviations: n.s., not significant; 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

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getmorefigures.php?uid=PMC4836939&req=5

FI1400113-3: Sensitivity rate for single-modality monitoring group. Abbreviations: n.s., not significant; 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: The SIOM group included 22 cases of postoperative motor deficit, in which 17/884 cases (1.9%) occurred with TcMEP, 3/140 cases (2.1%) with Sp-SCEP, and 2/372 cases (0.5%) with SSEP. The overall sensitivity and specificity in the SIOM group were 72 and 95%, respectively, with a false-positive rate of 5%. Review of each type of monitoring revealed that TcMEP had a significantly higher sensitivity (82%) than Sp-SCEP. The sensitivity was significantly lower in the cases where only Sp-SCEP or SSEP was conducted (SSEP: 50%, Sp-SCEP: 33%; see Fig. 3 and Table 4).

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