TY - JOUR
T1 - Intraoperative Deterioration of Neurophysiological Potentials of the Spinal Tracts in Cervical Spine Surgery
T2 - Correlation with Patient-Related and Procedure-Related Variables
AU - Michaeli, Avner
AU - Appel, Shmuel
AU - Danto, Joseph
AU - Korn, Akiva
AU - Schroeder, Josh E.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Purpose:To identify characteristics associated with higher incidence of intraoperative deterioration of neurophysiological potentials related to spinal tracts in cervical spine surgeries.Methods:Electrophysiological raw data and neurophysiological case reports of 1,611 patients from multiple medical centers, who underwent cervical spine surgery for decompression and/or fusion, were retrospectively reviewed. Patient-related and procedure-related variables were identified and analyzed for correlation with intraoperative neurophysiological event of the spinal tracts. The neurophysiological events were analyzed for identification of collective characteristics.Results:The study cohort presented consistent dominancy of male over female patients (67% vs. 33%). Intraoperative deterioration of spinal tract-derived potentials was noted in 10.5% of the total cases, which was not correlated with gender, age, or indication of the surgery. Higher incidence of neurophysiological events was noted in patients with impaired baseline of motor evoked potentials from the thenar muscle (P = 0.01) or somatosensory evoked potentials of the posterior tibial nerve (P = 0.0002). Procedures of circumferential approach or procedures that involved ≥3 spinal levels demonstrated higher incidence of neurophysiological events as well (P = 0.0003 and 0.001, respectively).Conclusions:Patients with deteriorated neurophysiological baseline and procedures of extensive intervention are at higher risk of intraoperative neurophysiological event in cervical spine surgery. Inclusion of intraoperative neurophysiological monitoring should be encouraged in complicated cases of cervical spine surgeries.
AB - Purpose:To identify characteristics associated with higher incidence of intraoperative deterioration of neurophysiological potentials related to spinal tracts in cervical spine surgeries.Methods:Electrophysiological raw data and neurophysiological case reports of 1,611 patients from multiple medical centers, who underwent cervical spine surgery for decompression and/or fusion, were retrospectively reviewed. Patient-related and procedure-related variables were identified and analyzed for correlation with intraoperative neurophysiological event of the spinal tracts. The neurophysiological events were analyzed for identification of collective characteristics.Results:The study cohort presented consistent dominancy of male over female patients (67% vs. 33%). Intraoperative deterioration of spinal tract-derived potentials was noted in 10.5% of the total cases, which was not correlated with gender, age, or indication of the surgery. Higher incidence of neurophysiological events was noted in patients with impaired baseline of motor evoked potentials from the thenar muscle (P = 0.01) or somatosensory evoked potentials of the posterior tibial nerve (P = 0.0002). Procedures of circumferential approach or procedures that involved ≥3 spinal levels demonstrated higher incidence of neurophysiological events as well (P = 0.0003 and 0.001, respectively).Conclusions:Patients with deteriorated neurophysiological baseline and procedures of extensive intervention are at higher risk of intraoperative neurophysiological event in cervical spine surgery. Inclusion of intraoperative neurophysiological monitoring should be encouraged in complicated cases of cervical spine surgeries.
KW - Cervical spine surgery
KW - Intraoperative neurophysiological event
KW - Motor evoked potential
KW - Somatosensory evoked potential
KW - Spinal long tracts
UR - http://www.scopus.com/inward/record.url?scp=85159553340&partnerID=8YFLogxK
U2 - 10.1097/WNP.0000000000000889
DO - 10.1097/WNP.0000000000000889
M3 - Article
C2 - 35089908
AN - SCOPUS:85159553340
SN - 0736-0258
VL - 40
SP - 325
EP - 330
JO - Journal of Clinical Neurophysiology
JF - Journal of Clinical Neurophysiology
IS - 4
ER -