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Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis

Transcranial motor-evoked potentials (TcMEPs) are used to monitor the descending motor pathway during scoliosis surgery. By comparing potentials before and after correction, surgeons may prevent postoperative functional loss in distal muscles. There is currently no consensus as to which muscles shou...

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Autores principales: Miller, Samuel M., Donegan, Sean W., Voigt, Niesha, Eltorai, Adam E.M., Nguyen, Joseph, Machan, Jason T., Daniels, Alan H., Shetty, Teena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: PAGEPress Publications, Pavia, Italy 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452093/
https://www.ncbi.nlm.nih.gov/pubmed/30996839
http://dx.doi.org/10.4081/or.2019.7757
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author Miller, Samuel M.
Donegan, Sean W.
Voigt, Niesha
Eltorai, Adam E.M.
Nguyen, Joseph
Machan, Jason T.
Daniels, Alan H.
Shetty, Teena
author_facet Miller, Samuel M.
Donegan, Sean W.
Voigt, Niesha
Eltorai, Adam E.M.
Nguyen, Joseph
Machan, Jason T.
Daniels, Alan H.
Shetty, Teena
author_sort Miller, Samuel M.
collection PubMed
description Transcranial motor-evoked potentials (TcMEPs) are used to monitor the descending motor pathway during scoliosis surgery. By comparing potentials before and after correction, surgeons may prevent postoperative functional loss in distal muscles. There is currently no consensus as to which muscles should be monitored. The purpose of this study is to determine the least invasive monitoring protocol with the best localization of potential neurologic deficit. A retrospective review of 125 patients with TcMEP monitoring during surgery for thoracolumbar scoliosis between 2008 and 2015 was conducted. 18 patients had postoperative neurologic consult due to deficit. The remaining 107 patients were a consecutive cohort without postoperative neurologic consult. TcMEPs were recorded from vastus lateralis (VL), tibialis anterior (TA), peroneus longus (PL), adductor hallucis (AH) and abductor pollicis brevis (APB) bilaterally. The effectiveness of each muscle combination was evaluated independently and then compared to other combinations using Akaike Information Criterion (AIC). Monitoring of VL, TA, PL, and AH yielded sensitivity of 77.8% and specificity of 92.5% (AIC=66.7). Monitoring of TA, PL and AH yielded sensitivity of 77.8% and specificity of 94.4% (AIC=62.4). Monitoring of VL, TA and PL yielded sensitivity of 72.2% and specificity of 93.5% (AIC=70.1). Monitoring of TA and PL yielded sensitivity of 72.2% and specificity of 96.3% (AIC=63.9). TcMEP monitoring of TA, PL, and AH provided the highest sensitivity and specificity and best predictive power for postoperative lower extremity weakness.
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spelling pubmed-64520932019-04-17 Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis Miller, Samuel M. Donegan, Sean W. Voigt, Niesha Eltorai, Adam E.M. Nguyen, Joseph Machan, Jason T. Daniels, Alan H. Shetty, Teena Orthop Rev (Pavia) Article Transcranial motor-evoked potentials (TcMEPs) are used to monitor the descending motor pathway during scoliosis surgery. By comparing potentials before and after correction, surgeons may prevent postoperative functional loss in distal muscles. There is currently no consensus as to which muscles should be monitored. The purpose of this study is to determine the least invasive monitoring protocol with the best localization of potential neurologic deficit. A retrospective review of 125 patients with TcMEP monitoring during surgery for thoracolumbar scoliosis between 2008 and 2015 was conducted. 18 patients had postoperative neurologic consult due to deficit. The remaining 107 patients were a consecutive cohort without postoperative neurologic consult. TcMEPs were recorded from vastus lateralis (VL), tibialis anterior (TA), peroneus longus (PL), adductor hallucis (AH) and abductor pollicis brevis (APB) bilaterally. The effectiveness of each muscle combination was evaluated independently and then compared to other combinations using Akaike Information Criterion (AIC). Monitoring of VL, TA, PL, and AH yielded sensitivity of 77.8% and specificity of 92.5% (AIC=66.7). Monitoring of TA, PL and AH yielded sensitivity of 77.8% and specificity of 94.4% (AIC=62.4). Monitoring of VL, TA and PL yielded sensitivity of 72.2% and specificity of 93.5% (AIC=70.1). Monitoring of TA and PL yielded sensitivity of 72.2% and specificity of 96.3% (AIC=63.9). TcMEP monitoring of TA, PL, and AH provided the highest sensitivity and specificity and best predictive power for postoperative lower extremity weakness. PAGEPress Publications, Pavia, Italy 2019-03-12 /pmc/articles/PMC6452093/ /pubmed/30996839 http://dx.doi.org/10.4081/or.2019.7757 Text en ©Copyright S. M. Miller et al., 2019 http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Article
Miller, Samuel M.
Donegan, Sean W.
Voigt, Niesha
Eltorai, Adam E.M.
Nguyen, Joseph
Machan, Jason T.
Daniels, Alan H.
Shetty, Teena
Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis
title Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis
title_full Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis
title_fullStr Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis
title_full_unstemmed Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis
title_short Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis
title_sort transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452093/
https://www.ncbi.nlm.nih.gov/pubmed/30996839
http://dx.doi.org/10.4081/or.2019.7757
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