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Intraoperative neurophysiologic spinal cord monitoring in thoracolumbar burst fractures.
Spine (Phila Pa 1976). 2009 Nov 15; 34(24):2662-8.S

Abstract

STUDY DESIGN

Clinical prospective cohort study in academic tertiary setting.

OBJECTIVE

Evaluate intraoperative neurophysiologic monitoring of the spinal cord in patients with thoracolumbar burst fractures.

SUMMARY OF BACKGROUND DATA

The majority of clinical studies using intraoperative neurophysiologic monitoring in spinal trauma focus exclusively on somatosensory-evoked potentials (SSEP), and there are no specific article on the use of transcranial motor-evoked potentials (TcMEP), and stimulated electromyography (SEMG) by direct stimulation of the pedicular screws in thoracolumbar burst type fractures. In addition, controversy regarding the relation between spinal cord decompression and improvement in spinal cord function in such patients remains.

METHODS

Eighteen patients with thoracolumbar burst type fractures (<3 weeks) who underwent indirect posterior spinal cord decompression was carried out from 2002 to 2006. Patients were monitored intraoperatively by SSEP, TcMEP, and SEMG. Findings that suggested worsening of spinal cord function were as follows: reduction in SSEP amplitude greater than 50% or increased latency time of 10%; and increased TcMEP of 100 V. Signs of improvement were 20% increase in SSEP amplitude and 20% decrease in TcMEP stimuli intensity. Four (22%) patients presented neurologic deficit. The mean American Spinal Injury Association (1993) score for motor function was 99+/-29 (range, 90-100). The mean American Spinal Injury Association (1993) score for sensory function was 111+/-32 (range, 107-112).

RESULTS

There were no significant changes in the spinal cord function during the surgical procedure, although a decrease in the mean latency could be observed after spinal cord decompression (43.21x40.86; P<0.01). Two screws triggered SEMG responses and were replaced. All cases were true negatives.

CONCLUSION

No significant changes in spinal cord function (to better or worse) were found in the current series after indirect spinal cord decompression through a posterior approach in patients with mild or no neurologic deficits. Further studies with larger series of patients presenting severe neurologic deficits are necessary to better establish these findings.

Authors+Show Affiliations

Department of Orthopaedics and Traumatology, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, Brazil.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19910769

Citation

Castellon, Alfredo T., et al. "Intraoperative Neurophysiologic Spinal Cord Monitoring in Thoracolumbar Burst Fractures." Spine, vol. 34, no. 24, 2009, pp. 2662-8.
Castellon AT, Meves R, Avanzi O. Intraoperative neurophysiologic spinal cord monitoring in thoracolumbar burst fractures. Spine. 2009;34(24):2662-8.
Castellon, A. T., Meves, R., & Avanzi, O. (2009). Intraoperative neurophysiologic spinal cord monitoring in thoracolumbar burst fractures. Spine, 34(24), 2662-8. https://doi.org/10.1097/BRS.0b013e3181bf151b
Castellon AT, Meves R, Avanzi O. Intraoperative Neurophysiologic Spinal Cord Monitoring in Thoracolumbar Burst Fractures. Spine. 2009 Nov 15;34(24):2662-8. PubMed PMID: 19910769.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative neurophysiologic spinal cord monitoring in thoracolumbar burst fractures. AU - Castellon,Alfredo T, AU - Meves,Robert, AU - Avanzi,Osmar, PY - 2009/11/14/entrez PY - 2009/11/17/pubmed PY - 2010/2/27/medline SP - 2662 EP - 8 JF - Spine JO - Spine VL - 34 IS - 24 N2 - STUDY DESIGN: Clinical prospective cohort study in academic tertiary setting. OBJECTIVE: Evaluate intraoperative neurophysiologic monitoring of the spinal cord in patients with thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: The majority of clinical studies using intraoperative neurophysiologic monitoring in spinal trauma focus exclusively on somatosensory-evoked potentials (SSEP), and there are no specific article on the use of transcranial motor-evoked potentials (TcMEP), and stimulated electromyography (SEMG) by direct stimulation of the pedicular screws in thoracolumbar burst type fractures. In addition, controversy regarding the relation between spinal cord decompression and improvement in spinal cord function in such patients remains. METHODS: Eighteen patients with thoracolumbar burst type fractures (<3 weeks) who underwent indirect posterior spinal cord decompression was carried out from 2002 to 2006. Patients were monitored intraoperatively by SSEP, TcMEP, and SEMG. Findings that suggested worsening of spinal cord function were as follows: reduction in SSEP amplitude greater than 50% or increased latency time of 10%; and increased TcMEP of 100 V. Signs of improvement were 20% increase in SSEP amplitude and 20% decrease in TcMEP stimuli intensity. Four (22%) patients presented neurologic deficit. The mean American Spinal Injury Association (1993) score for motor function was 99+/-29 (range, 90-100). The mean American Spinal Injury Association (1993) score for sensory function was 111+/-32 (range, 107-112). RESULTS: There were no significant changes in the spinal cord function during the surgical procedure, although a decrease in the mean latency could be observed after spinal cord decompression (43.21x40.86; P<0.01). Two screws triggered SEMG responses and were replaced. All cases were true negatives. CONCLUSION: No significant changes in spinal cord function (to better or worse) were found in the current series after indirect spinal cord decompression through a posterior approach in patients with mild or no neurologic deficits. Further studies with larger series of patients presenting severe neurologic deficits are necessary to better establish these findings. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/19910769/Intraoperative_neurophysiologic_spinal_cord_monitoring_in_thoracolumbar_burst_fractures_ L2 - http://dx.doi.org/10.1097/BRS.0b013e3181bf151b DB - PRIME DP - Unbound Medicine ER -