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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

Sensitivity rate for multimodal intraoperative monitoring group. Abbreviations: Br-SCEP, cord evoked potential after stimulation to the brain; 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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FI1400113-4: Sensitivity rate for multimodal intraoperative monitoring group. Abbreviations: Br-SCEP, cord evoked potential after stimulation to the brain; 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 MIOM group included 37 cases of postoperative paralysis, in which 10/540 cases (1.9%) occurred with TcMEP + Br-SCEP, 19/718 cases (2.8%) with TcMEP + SSEP, 5/247 cases (2.0%) with TcMEP + Sp-SCEP, and 2/127 cases (2.0%) with Br-SCEP + Sp-SCEP. The overall sensitivity and specificity in the MIOM group were 81 and 92%, respectively, with the sensitivity higher than in SIOM group, but the difference was not statistically significant. The comparison of the various combinations showed the TcMEP + Br-SCEP combination to have the highest sensitivity of 90%. The TcMEP + SSEP and TcMEP + 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% among Br-SCEP + Sp-SCEP cases (i.e., the cases where TcMEP was not included; see Fig. 4 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 multimodal intraoperative monitoring group. Abbreviations: Br-SCEP, cord evoked potential after stimulation to the brain; 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

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

FI1400113-4: Sensitivity rate for multimodal intraoperative monitoring group. Abbreviations: Br-SCEP, cord evoked potential after stimulation to the brain; 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 MIOM group included 37 cases of postoperative paralysis, in which 10/540 cases (1.9%) occurred with TcMEP + Br-SCEP, 19/718 cases (2.8%) with TcMEP + SSEP, 5/247 cases (2.0%) with TcMEP + Sp-SCEP, and 2/127 cases (2.0%) with Br-SCEP + Sp-SCEP. The overall sensitivity and specificity in the MIOM group were 81 and 92%, respectively, with the sensitivity higher than in SIOM group, but the difference was not statistically significant. The comparison of the various combinations showed the TcMEP + Br-SCEP combination to have the highest sensitivity of 90%. The TcMEP + SSEP and TcMEP + 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% among Br-SCEP + Sp-SCEP cases (i.e., the cases where TcMEP was not included; see Fig. 4 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