Department of Neurology, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA.
Department of Neurology, Houston Methodist Health System, 6560 Fannin Street, Houston, TX 77030, USA.
Spine J. 2024 Sep;24(9):1660-1670. doi: 10.1016/j.spinee.2024.04.029. Epub 2024 Apr 27.
Transcranial Motor Evoked Potentials (TcMEPs) can improve intraoperative detection of femoral plexus and nerve root injury during lumbosacral spine surgery. However, even under ideal conditions, TcMEPs are not completely free of false-positive alerts due to the immobilizing effect of general anesthetics, especially in the proximal musculature. The application of transcutaneous stimulation to activate ventral nerve roots directly at the level of the conus medularis (bypassing the brain and spinal cord) has emerged as a method to potentially monitor the motor component of the femoral plexus and lumbosacral nerves free from the blunting effects of general anesthesia.
To evaluate the reliability and efficacy of transabdominal motor evoked potentials (TaMEPs) compared to TcMEPs during lumbosacral spine procedures.
We present the findings of a single-center 12-month retrospective experience of all lumbosacral spine surgeries utilizing multimodality intraoperative neuromonitoring (IONM) consisting of TcMEPs, TaMEPs, somatosensory evoked potentials (SSEPs), electromyography (EMG), and electroencephalography.
Two hundred and twenty patients having one, or a combination of lumbosacral spine procedures, including anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), posterior spinal fusion (PSF), and/or transforaminal lumbar interbody fusion (TLIF).
Intraoperative neuromonitoring data was correlated to immediate postoperative neurologic examinations and chart review.
Baseline reliability, false positive rate, true positive rate, false negative rate, area under the curve at baseline and at alerts, and detection of preoperative deficits of TcMEPs and TaMEPs were compared and analyzed for statistical significance. The relationship between transcutaneous stimulation voltage level and patient BMI was also examined.
TaMEPs were significantly more reliable than TcMEPs in all muscles except abductor hallucis. Of the 27 false positive alerts, 24 were TcMEPs alone, and 3 were TaMEPs alone. Of the 19 true positives, none were detected by TcMEPs alone, 3 were detected by TaMEPs alone (TcMEPs were not present), and the remaining 16 true positives involved TaMEPs and TcMEPs. TaMEPs had a significantly larger area under the curve (AUC) at baseline than TcMEPs in all muscles except abductor hallucis. The percent decrease in TcMEP and TaMEP AUC during LLIF alerts was not significantly different. Both TcMEPs and TaMEPs reflected three preexisting motor deficits. Patient BMI and TaMEP stimulation intensity were found to be moderately positively correlated.
These findings demonstrate the high reliability and predictability of TaMEPs and the potential added value when TaMEPs are incorporated into multimodality IONM during lumbosacral spine surgery.
经颅运动诱发电位（TcMEP）可提高腰骶部脊柱手术中股神经丛和神经根损伤的术中检测。然而，即使在理想条件下，由于全身麻醉的固定作用，TcMEP 也并非完全没有假阳性警报，尤其是在近端肌肉中。经皮刺激直接在脊髓圆锥水平激活腹神经根（绕过大脑和脊髓）已成为一种监测股神经丛和腰骶神经运动成分的方法，不受全身麻醉的影响。
评估经腹运动诱发电位（TaMEP）在腰骶部脊柱手术中的可靠性和效果与 TcMEP 相比。
我们介绍了一项单中心为期 12 个月的回顾性研究结果，该研究纳入了所有接受多模态术中神经监测（IONM）的腰骶部脊柱手术，IONM 包括 TcMEP、TaMEP、体感诱发电位（SSEP）、肌电图（EMG）和脑电图。
220 例患者接受了一次或一次以上的腰骶部脊柱手术，包括前路腰椎间融合术（ALIF）、侧路腰椎间融合术（LLIF）、后路脊柱融合术（PSF）和/或经椎间孔腰椎间融合术（TLIF）。
术中神经监测数据与术后即刻神经检查和病历回顾相关。
比较并分析了基线可靠性、假阳性率、真阳性率、假阴性率、基线和报警时的曲线下面积以及 TcMEP 和 TaMEP 术前缺陷的检测，以进行统计学意义分析。还检查了经皮刺激电压水平与患者 BMI 之间的关系。
TaMEP 在除拇展肌外的所有肌肉中的可靠性均明显优于 TcMEP。27 次假阳性警报中，24 次仅为 TcMEP，3 次仅为 TaMEP。19 次真阳性中，无一例仅由 TcMEP 检测到，3 例仅由 TaMEP 检测到（未检测到 TcMEP），其余 16 例真阳性涉及 TaMEP 和 TcMEP。除拇展肌外，TaMEP 在所有肌肉中的基线曲线下面积（AUC）均明显大于 TcMEP。LLIF 警报期间 TcMEP 和 TaMEP AUC 的降低百分比没有显著差异。TcMEP 和 TaMEP 均反映了三个预先存在的运动缺陷。发现患者 BMI 和 TaMEP 刺激强度呈中度正相关。
这些发现表明 TaMEP 具有很高的可靠性和可预测性，并且在腰骶部脊柱手术中，将 TaMEP 纳入多模态 IONM 时具有潜在的附加价值。
