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 Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.
Adult
Aged
Biomedical Research
Decompression, Surgical
/ methods
Evoked Potentials, Motor
/ physiology
Female
Humans
Intraoperative Neurophysiological Monitoring
/ methods
Japan
Male
Middle Aged
Ossification of Posterior Longitudinal Ligament
/ diagnostic imaging
Prospective Studies
Societies, Medical
Spinal Fusion
/ methods
Thoracic Vertebrae
/ diagnostic imaging
Treatment Outcome
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Feb 2021
15 Feb 2021
Historique:
pubmed:
7
11
2020
medline:
14
4
2021
entrez:
6
11
2020
Statut:
ppublish
Résumé
Prospective, multicenter, observational study. 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). T-OPLL is commonly treated with posterior decompression and fusion with instrumentation. IONM using Tc-MEPs during surgery reduces the risk of neurological complications. 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. 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. These results show the efficacy of intraoperative intervention following a Tc-MEP alert for prevention of neurological deficit postoperatively.Level of Evidence: 2.
Sections du résumé
STUDY DESIGN
METHODS
Prospective, multicenter, observational study.
OBJECTIVE
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
BACKGROUND
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
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
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
CONCLUSIONS
These results show the efficacy of intraoperative intervention following a Tc-MEP alert for prevention of neurological deficit postoperatively.Level of Evidence: 2.
Identifiants
pubmed: 33156280
pii: 00007632-202102150-00016
doi: 10.1097/BRS.0000000000003774
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
268-276Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Références
Yamazaki M, Koda M, Okawa A, et al. Transient paraparesis after laminectomy for thoracic ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum. Spinal Cord 2006; 44:130–134.
Matsumoto M, Toyama Y, Chikuda H, et al. Outcomes of fusion surgery for ossification of the posterior longitudinal ligament of the thoracic spine: a multicenter retrospective survey: clinical article. J Neurosurg Spine 2011; 15:380–385.
Kawahara N, Tomita K, Murakami H, et al. Circumspinal decompression with dekyphosis stabilization for thoracic myelopathy due to ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 2008; 33:39–46.
Ohtani K, Nakai S, Fujimura Y, et al. Anterior surgical decompression for thoracic myelopathy as a result of ossification of the posterior longitudinal ligament. Clin Orthop Relat Res 1982; 166:82–88.
Takahata M, Ito M, Abumi K, et al. Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine (Phila Pa 1976) 2008; 33:1199–1208.
Tokuhashi Y, Matsuzaki H, Oda H, et al. Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine: usefulness of the ossification-kyphosis angle on MRI. Spine (Phila Pa 1976) 2006; 31:E26–30.
Tomita K, Kawahara N, Baba H, et al. Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and ligamentum flavum. Spine (Phila Pa 1976) 1990; 15:1114–1120.
Yamazaki M, Okawa A, Fujiyoshi T, et al. Posterior decompression with instrumented fusion for thoracicmyelopathy caused by ossification of the posterior longitudinal ligament. Eur Spine J 2010; 19:691–698.
Matsumoto M, Chiba K, Toyama Y, et al. Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine: a multi-institutional retrospective study. Spine (Phila Pa 1976) 2008; 33:1034–1041.
Fujimura Y, Nishi Y, Nakamura M, et al. Long-term follow-up study of anterior decompression and fusion for thoracic myelopathy resulting from ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 1997; 22:305–311.
Aizawa T, Sato T, Sasaki H, et al. Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. J Neurosurg Spine 2007; 7:13–20.
Yamazaki M, Mochizuki M, Ikeda Y, et al. Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion. Spine (Phila Pa 1976) 2006; 31:1452–1460.
Matsuyama Y, Yoshihara H, Tsuji T, et al. Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options. J Spinal Disord Tech 2005; 18:492–497.
Imagama S, Ando K, Kobayashi K, et al. Factors for a good surgical outcome in posterior decompression and dekyphotic corrective fusion with instrumentation for thoracic ossification of the posterior longitudinal ligament: prospective single-center study. Oper Neurosurg 2017; 13:661–669.
Ando K, Kobayashi K, Machino M, et al. Wave changes in intraoperative transcranial motor-evoked potentials during posterior decompression and dekyphotic corrective fusion with instrumentation for thoracic ossification of the posterior longitudinal ligament. Eur J Orthop Surg Traumatol 2019; 29:1177–1185.
Imagama S, Ando K, Ito Z, et al. Resection of beak-type thoracic ossification of the posterior longitudinal ligament from a posterior approach under intraoperative neurophysiological monitoring for paralysis after posterior decompression and fusion surgery. Global Spine J 2016; 6:812–821.
Ito Z, Matsuyama Y, Ando M, et al. Postoperative paralysis from thoracic ossification of posterior longitudinal ligament surgery risk factor of neurologic injury: Nationwide multiinstitution survey. Spine (Spine 1976) 2016; 41:E1159–E1163.
Matsuyama Y, Sakai Y, Katayama Y, et al. Indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine: is it possible to predict the surgical results? Eur Spine J 2009; 18:943–948.
Imagama S, Ando K, Takeuchi K, et al. Perioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study. Spine (Phila Pa 1976) 2018; 43:E1389–E1397.
Hilibrand AS, Schwartz DM, Sethuraman V, et al. Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery. J Bone Joint Surg Am 2004; 86-A:1248–1253.
Kelleher MO, Tan G, Sarjeant R, et al. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine 2008; 8:215–221.
Muramoto A, Imagama S, Ito Z, et al. The cutoff amplitude of transcranial motor-evoked potentials for predicting postoperative motor deficits in thoracic spine surgery. Spine (Phila Pa 1976) 2013; 38:E21–E27.
Yoshida G, Ando M, Imagama S, et al. Alert timing and corresponding intervention with intraoperative spinal cord monitoring for high-risk spinal surgery. Spine (Phila Pa 1976) 2019; 44:E470–E479.
Kobayashi K, Imagama S, Ito Z, et al. Transcranial motor evoked potential waveform changes in corrective fusion for adolescent idiopathic scoliosis. J Neurosurg Pediatr 2017; 19:108–115.
Kobayashi K, Imagama S, Ito Z, et al. Prevention of spinal cord injury using brain-evoked muscle-action potential (Br(E)-MsEP) monitoring in cervical spinal screw fixation. Eur Spine J 2017; 26:1154–1161.
Kobayashi K, Ando K, Shinjo R, et al. A new criterion for the alarm point using a combination of waveform amplitude and onset latency in Br(E)-MsEP monitoring in spine surgery. J Neurosurg Spine 2018; 29:435–441.
Kobayashi K, Imagama S, Ando K, et al. Analysis of incident and accident reports and risk management in spine surgery. Spine (Phila Pa 1976) 2017; 42:1184–1188.
Kobayashi K, Ando K, Shinjo R, et al. Evaluation of a combination of waveform amplitude and peak latency in intraoperative spinal cord monitoring. Spine (Phila Pa 1976) 2018; 43:1231–1237.
Kobayashi S, Matsuyama Y, Shinomiya K, et al. A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research. J Neurosurg Spine 2014; 20:102–107.
Deletis V. Basic methodological principles of multimodal intraoperative monitoring during spine surgeries. Eur Spine J 2007; 16:S147–S152.
Ando K, Imagama S, Ito Z, et al. Ponte osteotomy during dekyphosis for indirect posterior decompression with ossification of the posterior longitudinal ligament of the thoracic spine. Clin Spine Surg 2017; 30:E358–E362.
Ito Z, Imagama S, Sakai Y, et al. A new criterion for the alarm point for compound muscle action potentials. Clinical article. J Neurosurg Spine 2012; 17:348–356.
Muramoto A, Imagama S, Ito Z, et al. The cutoff amplitude of transcranial motor evoked potentials for transient postoperative motor deficits in intramedullary spinal cord tumor surgery. Spine (Phila Pa 1976) 2014; 39:E1086–E1094.
Yamada K, Matsuyama Y, Kobayashi S, et al. Evaluation of the alarm criteria for transcranial electrical stimulation muscle evoked potential in spinal deformity surgery: multi-institution survey by the spinal cord monitoring committee of the Japanese society for spine surgery and related research. J Spine Res 2015; 6:1354–1362.
Imagama S, Ando K, Kobayashi K, et al. Atypical vertebral column fracture at the middle of fused area after instrumented posterior decompression and fusion surgery for beak type thoracic ossification of the posterior longitudinal ligament. J Orthop Sci 2018; 23:1000–1004.
Imagama S, Ito Z, Ando K, et al. Tips for good surgical results of indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine. Rinsho Seikei Geka 2012; 47:829–835.
Pham MH, Attenello FJ, Lucas J, et al. Conservative management of ossification of the posterior longitudinal ligament. A review. Neurosurg Focus 2011; 30:E2.
Xu N, Yu M, Liu X, et al. A systematic review of complications in thoracic spine surgery for ossification of the posterior longitudinal ligament. Eur Spine J 2017; 26:1803–1809.
Imagama S, Ando K, Ito Z, et al. Risk factors for ineffectiveness of posterior decompression and dekyphotic corrective fusion with instrumentation for beak-type thoracic ossification of the posterior longitudinal ligament: a single institute study. Neurosurgery 2017; 80:800–808.
Kobayashi K, Ando K, Tsushima M, et al. Characteristics of multi-channel Br(E)-MsEP waveforms for the lower extremity muscles in thoracic spine surgery: comparison based on preoperative motor status. Eur Spine J 2019; 28:484–491.
Ito Z, Matsuyama Y, Ando M, et al. What is the best multimodality combination for intraoperative spinal cord monitoring of motor function? A multicenter study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research. Global Spine J 2016; 6:234–241.