Tags

Type your tag names separated by a space and hit enter

Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation.
Spine (Phila Pa 1976). 2009 Jun 15; 34(14):1504-12.S

Abstract

STUDY DESIGN

A retrospective analysis of prospectively collected data of 102 consecutive adult patients who underwent intraoperative neurophysiological monitoring (IOM) during spinal deformity corrective surgery.

OBJECTIVE

To report the sensitivity and specificity of combined IOM in this study population using the postoperative neurologic examination as the "gold standard."

SUMMARY OF BACKGROUND DATA

IOM is recommended during corrective spinal surgery and has been widely used in the pediatric deformity population. However, there are limited data describing the application of IOM in adults undergoing spinal deformity corrective surgery.

METHODS

The study group consisted of 102 patients undergoing spinal deformity corrective surgery between 2001 and 2004. Patients were monitored using at least 2 or more electrophysiological methods including somatosensory-evoked potentials (SSEP), motor-evoked potentials (MEP), and electromyography (EMG).

RESULTS

The mean age of patients was 41.5 years (+/-17). The majority of the operative procedures involved instrumented fusion from thoracic to lumbar/sacral spine (n = 55), thoracic-pelvis fusion (n = 26), and a combined total of 32 osteotomies (including 25 pedicle subtraction osteotomies and 7 Smith-Peterson osteotomies). SSEPs were recorded successfully in 101 (99%), EMGs in 89 of 102 (87%), and MEPs in 12 of 16 (75%). Five cases were true positives (4.95%), and these were all detected by combined monitoring (2-SSEP, 2-EMG, 1-MEP). There were no false positives with SSEPs, but EMG resulted in 30 of 89 (34%) false positives. There were 4 false negatives with SSEPs, which reduced its sensitivity to 33%. There was 1 false negative with EMG, and 0 with MEPs. When these results were collated, the overall sensitivity of combined multimodality IOM in this adult deformity series was 100%, specificity 84.3%, PPV 13.9%, and NPV 97%. The combined sensitivity in the osteotomy group (n = 32) was 67%, specificity 98%, PPV 80%, and NPV 96%. In comparison, there were no IOM abnormalities in those patients who had in situ/minor corrective procedures (n = 18; largely adult degenerative scoliosis).

CONCLUSION

Multimodality IOM of spinal cord sensory and motor function during surgical correction of adult spinal deformity is feasible and provides useful neurophysiological data with an overall sensitivity of 100% and a specificity of 84.3% (67% and 98%, respectively in patients undergoing major deformity correction).

Authors+Show Affiliations

Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19483667

Citation

Quraishi, Nasir A., et al. "Intraoperative Multimodality Monitoring in Adult Spinal Deformity: Analysis of a Prospective Series of One Hundred Two Cases With Independent Evaluation." Spine, vol. 34, no. 14, 2009, pp. 1504-12.
Quraishi NA, Lewis SJ, Kelleher MO, et al. Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine. 2009;34(14):1504-12.
Quraishi, N. A., Lewis, S. J., Kelleher, M. O., Sarjeant, R., Rampersaud, Y. R., & Fehlings, M. G. (2009). Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine, 34(14), 1504-12. https://doi.org/10.1097/BRS.0b013e3181a87b66
Quraishi NA, et al. Intraoperative Multimodality Monitoring in Adult Spinal Deformity: Analysis of a Prospective Series of One Hundred Two Cases With Independent Evaluation. Spine. 2009 Jun 15;34(14):1504-12. PubMed PMID: 19483667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. AU - Quraishi,Nasir A, AU - Lewis,Stephen J, AU - Kelleher,Michael O, AU - Sarjeant,Roger, AU - Rampersaud,Yoga R, AU - Fehlings,Michael G, PY - 2009/6/2/entrez PY - 2009/6/2/pubmed PY - 2009/9/26/medline SP - 1504 EP - 12 JF - Spine JO - Spine VL - 34 IS - 14 N2 - STUDY DESIGN: A retrospective analysis of prospectively collected data of 102 consecutive adult patients who underwent intraoperative neurophysiological monitoring (IOM) during spinal deformity corrective surgery. OBJECTIVE: To report the sensitivity and specificity of combined IOM in this study population using the postoperative neurologic examination as the "gold standard." SUMMARY OF BACKGROUND DATA: IOM is recommended during corrective spinal surgery and has been widely used in the pediatric deformity population. However, there are limited data describing the application of IOM in adults undergoing spinal deformity corrective surgery. METHODS: The study group consisted of 102 patients undergoing spinal deformity corrective surgery between 2001 and 2004. Patients were monitored using at least 2 or more electrophysiological methods including somatosensory-evoked potentials (SSEP), motor-evoked potentials (MEP), and electromyography (EMG). RESULTS: The mean age of patients was 41.5 years (+/-17). The majority of the operative procedures involved instrumented fusion from thoracic to lumbar/sacral spine (n = 55), thoracic-pelvis fusion (n = 26), and a combined total of 32 osteotomies (including 25 pedicle subtraction osteotomies and 7 Smith-Peterson osteotomies). SSEPs were recorded successfully in 101 (99%), EMGs in 89 of 102 (87%), and MEPs in 12 of 16 (75%). Five cases were true positives (4.95%), and these were all detected by combined monitoring (2-SSEP, 2-EMG, 1-MEP). There were no false positives with SSEPs, but EMG resulted in 30 of 89 (34%) false positives. There were 4 false negatives with SSEPs, which reduced its sensitivity to 33%. There was 1 false negative with EMG, and 0 with MEPs. When these results were collated, the overall sensitivity of combined multimodality IOM in this adult deformity series was 100%, specificity 84.3%, PPV 13.9%, and NPV 97%. The combined sensitivity in the osteotomy group (n = 32) was 67%, specificity 98%, PPV 80%, and NPV 96%. In comparison, there were no IOM abnormalities in those patients who had in situ/minor corrective procedures (n = 18; largely adult degenerative scoliosis). CONCLUSION: Multimodality IOM of spinal cord sensory and motor function during surgical correction of adult spinal deformity is feasible and provides useful neurophysiological data with an overall sensitivity of 100% and a specificity of 84.3% (67% and 98%, respectively in patients undergoing major deformity correction). SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/19483667/Intraoperative_multimodality_monitoring_in_adult_spinal_deformity:_analysis_of_a_prospective_series_of_one_hundred_two_cases_with_independent_evaluation_ L2 - http://dx.doi.org/10.1097/BRS.0b013e3181a87b66 DB - PRIME DP - Unbound Medicine ER -