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Efficacy of Intraoperative Intervention Following Transcranial Motor-evoked Potentials Alert During Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study of the Monitor

Abstract：

STUDY DESIGN:Prospective, multicenter, observational study. OBJECTIVE:The aim of this study was to investigate the efficacy of intervention after an alert in intraoperative neurophysiological monitoring (IONM) using transcranial motor-evoked potentials (Tc-MEPs) during surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL). SUMMARY OF BACKGROUND DATA:T-OPLL is commonly treated with posterior decompression and fusion with instrumentation. IONM using Tc-MEPs during surgery reduces the risk of neurological complications. METHODS:The subjects were 79 patients with a Tc-MEP alert during posterior decompression and fusion surgery for T-OPLL. Preoperative muscle strength (manual muscle testing [MMT]), waveform derivation rate at the start of surgery (baseline), intraoperative waveform changes; and postoperative motor paralysis were examined. A reduction in MMT score of ≥1 on the day after surgery was classified as worsened postoperative motor deficit. An alert was defined as a decrease in Tc-MEP waveform amplitude of ≥70% from baseline. Alerts were recorded at key times during surgery. RESULTS:The patients (35 males, 44 females; age 54.6 years) had OPLL at T1-4 (n = 27, 34%), T5-8 (n = 50, 63%), and T9-12 (n = 16, 20%). The preoperative status included sensory deficit (n = 67, 85%), motor deficit (MMT ≤4) (n = 59, 75%), and nonambulatory (n = 26, 33%). At baseline, 76 cases (96%) had a detectable Tc-MEP waveform for at least one muscle, and the abductor hallucis had the highest rate of baseline waveform detection (n = 66, 84%). Tc-MEP alerts occurred during decompression (n = 47, 60%), exposure (n = 13, 16%), rodding (n = 5, 6%), pedicle screw insertion (n = 4, 5%), posture change (n = 4, 5%), dekyphosis (n = 2, 3%), and other procedures (n = 4, 5%). After intraoperative intervention, the rescue rate (no postoperative neurological deficit) was 57% (45/79), and rescue cases had a significantly better preoperative ambulatory status and a significantly higher baseline waveform derivation rate. CONCLUSION:These results show the efficacy of intraoperative intervention following a Tc-MEP alert for prevention of neurological deficit postoperatively.Level of Evidence: 2.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Kobayashi K,Imagama S,Yoshida G,Ando M,Kawabata S,Yamada K,Kanchiku T,Fujiwara Y,Taniguchi S,Iwasaki H,Tadokoro N,Takahashi M,Wada K,Yamamoto N,Shigematsu H,Funaba M,Yasuda A,Ushirozako H,Tani T,Matsuyama Y

doi

10.1097/BRS.0000000000003774

subject

Has Abstract

pub_date

2021-02-15 00:00:00

pages

268-276

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-202102150-00016

journal_volume

pub_type

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Efficacy of Intraoperative Intervention Following Transcranial Motor-evoked Potentials Alert During Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study of the Monitor