Relevance of Intraoperative D Wave in Spine and Spinal Cord Surgeries

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2012 Nov 20

PMID 23161419

Citations 34

Authors

Paolo Costa

Paola Peretta

Giuliano Faccani

Affiliations

Soon will be listed here.

Abstract

Purpose: The combined recordings of epidural-(D wave) and muscle motor evoked potentials (m-MEPs) have been proposed in many studies in intramedullary spinal cord tumour (IMSCT) surgery, although not all agree. Furthermore, the usefulness of the intraoperative monitoring of motor systems using these methods in other types of spine surgery has not yet been clearly confirmed. The aim of this study is to test the impact of intraoperative D wave on the monitorability and motor outcome in spine surgery.

Methods: Intraoperative recording of posterior tibial nerve somatosensory potentials, lower limb m-MEPs (LLm-MEPs) and epidurally recorded D wave caudally to the surgical level was attempted in a total of 103 spine and spinal cord surgeries (23 IMSCT, 55 extramedullary spinal cord tumours and 25 myelopathies).

Results: There was a 97.1 %, overall monitorability where at least 1 of the 3 modalities was applicable in 100 surgical procedures. Baseline LLm-MEPs were recorded bilaterally in 85 cases and unilaterally in 11. A caudal D wave was recorded in 97 cases. Transient, or persistent intraoperative modifications occurred in 14/23 IMSCT, 5/55 extramedullary spinal cord tumours and in 2/25 myelopathies. The presence of a persistent stable caudal D wave was predictive of a good motor outcome even when the LL-MEPs were absent and/or when lost during surgery.

Conclusions: Not only is intraoperative D wave recording to be considered mandatory in IMSCT surgery but it should also be attempted in other types of spine/spinal cord surgeries.

Citing Articles

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Accuracy of Intraoperative Neuromonitoring in the Diagnosis of Intraoperative Neurological Decline in the Setting of Spinal Surgery-A Systematic Review and Meta-Analysis.

Alvi M, Kwon B, Hejrati N, Tetreault L, Evaniew N, Skelly A Global Spine J. 2024; 14(3_suppl):105S-149S.

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Multimodal Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Tumors: A 10-Year Single Center Experience.

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PMID: 38201539 PMC: 10778263. DOI: 10.3390/cancers16010111.

References

Deletis V, Sala F . Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts. Clin Neurophysiol. 2007; 119(2):248-64. DOI: 10.1016/j.clinph.2007.09.135. View

Pechstein U, Cedzich C, Nadstawek J, Schramm J . Transcranial high-frequency repetitive electrical stimulation for recording myogenic motor evoked potentials with the patient under general anesthesia. Neurosurgery. 1996; 39(2):335-43; discussion 343-4. DOI: 10.1097/00006123-199608000-00020. View

McCormick P, Torres R, Post K, STEIN B . Intramedullary ependymoma of the spinal cord. J Neurosurg. 1990; 72(4):523-32. DOI: 10.3171/jns.1990.72.4.0523. View

Kothbauer K, Deletis V, Epstein F . Motor-evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures. Neurosurg Focus. 2006; 4(5):e1. DOI: 10.3171/foc.1998.4.5.4. View

Kothbauer K, Deletis V, Epstein F . Intraoperative spinal cord monitoring for intramedullary surgery: an essential adjunct. Pediatr Neurosurg. 1997; 26(5):247-54. DOI: 10.1159/000121199. View

Boyd S, Rothwell J, Cowan J, Webb P, Morley T, Asselman P . A method of monitoring function in corticospinal pathways during scoliosis surgery with a note on motor conduction velocities. J Neurol Neurosurg Psychiatry. 1986; 49(3):251-7. PMC: 1028723. DOI: 10.1136/jnnp.49.3.251. View

Jones S, Harrison R, Koh K, Mendoza N, Crockard H . Motor evoked potential monitoring during spinal surgery: responses of distal limb muscles to transcranial cortical stimulation with pulse trains. Electroencephalogr Clin Neurophysiol. 1996; 100(5):375-83. View

Calancie B, Molano M . Alarm criteria for motor-evoked potentials: what's wrong with the "presence-or-absence" approach?. Spine (Phila Pa 1976). 2008; 33(4):406-14. DOI: 10.1097/BRS.0b013e3181642a2f. View

MacDonald D, Janusz M . An approach to intraoperative neurophysiologic monitoring of thoracoabdominal aneurysm surgery. J Clin Neurophysiol. 2002; 19(1):43-54. DOI: 10.1097/00004691-200201000-00006. View

10.

MacDonald D . Intraoperative motor evoked potential monitoring: overview and update. J Clin Monit Comput. 2006; 20(5):347-77. DOI: 10.1007/s10877-006-9033-0. View

11.

HICKS R, Burke D, Stephen J . Monitoring spinal cord function during scoliosis surgery with Cotrel-Dubousset instrumentation. Med J Aust. 1991; 154(2):82-6. DOI: 10.5694/j.1326-5377.1991.tb120988.x. View

12.

Hyun S, Rhim S . Combined motor and somatosensory evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in 17 consecutive procedures. Br J Neurosurg. 2009; 23(4):393-400. DOI: 10.1080/02688690902964744. View

13.

PATTON H, AMASSIAN V . Single and multiple-unit analysis of cortical stage of pyramidal tract activation. J Neurophysiol. 1954; 17(4):345-63. DOI: 10.1152/jn.1954.17.4.345. View

14.

Quinones-Hinojosa A, Lyon R, Zada G, Lamborn K, Gupta N, Parsa A . Changes in transcranial motor evoked potentials during intramedullary spinal cord tumor resection correlate with postoperative motor function. Neurosurgery. 2005; 56(5):982-93. View

15.

Burke D, Hicks R, Stephen J, Woodforth I, Crawford M . Assessment of corticospinal and somatosensory conduction simultaneously during scoliosis surgery. Electroencephalogr Clin Neurophysiol. 1992; 85(6):388-96. DOI: 10.1016/0168-5597(92)90052-d. View

16.

Sala F, Palandri G, Basso E, Lanteri P, Deletis V, Faccioli F . Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery. 2006; 58(6):1129-43. DOI: 10.1227/01.NEU.0000215948.97195.58. View

17.

Cioni B, Meglio M, Rossi G . Intraoperative motor evoked potentials monitoring in spinal neurosurgery. Arch Ital Biol. 1999; 137(2-3):115-26. View