Abstract：
BACKGROUND: 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.
OBJECTIVE: To evaluate the reliability and efficacy of transabdominal motor evoked potentials (TaMEPs) compared to TcMEPs during lumbosacral spine procedures.
METHODS: 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.
METHODS: 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).
METHODS: Intraoperative neuromonitoring data was correlated to immediate postoperative neurologic examinations and chart review.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
OBJECTIVE: To evaluate the reliability and efficacy of transabdominal motor evoked potentials (TaMEPs) compared to TcMEPs during lumbosacral spine procedures.
METHODS: 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.
METHODS: 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).
METHODS: Intraoperative neuromonitoring data was correlated to immediate postoperative neurologic examinations and chart review.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：经颅运动诱发电位（TcMEPs）可以改善腰骶部脊柱手术中股丛和神经根损伤的术中检测。然而,即使在理想条件下,由于全身麻醉药的固定作用，TcMEP并非完全没有假阳性警报，尤其是在近端肌肉组织中。经皮刺激直接在延髓圆锥水平（绕过大脑和脊髓）激活腹侧神经根的应用已经成为一种潜在的监测股丛和腰骶神经运动成分的方法，而没有全身麻醉的钝化作用。
目的：评估腰骶部脊柱手术期间经腹部运动诱发电位（TaMEPs）与TcMEPs相比的可靠性和有效性。
方法：我们介绍了使用由TcMEP组成的多模态术中神经监测（IONM）的所有腰骶骨脊柱手术的单中心12个月回顾性经验的发现，泰默,体感诱发电位（SSEP），肌电图（EMG）和脑电图。
方法：二百二十名患者，或腰骶脊柱手术的组合，包括腰椎前路椎间融合术（ALIF），腰椎外侧椎间融合术(LLIF),后路脊柱融合术(PSF),和/或经椎间孔腰椎椎间融合术（TLIF）。
方法：术中神经监测数据与术后即刻的神经系统检查和图表回顾相关。
方法：基线可靠性，假阳性率,真阳性率，假阴性率，基线和警报时曲线下的面积，并对TcMEPs和TaMEPs的术前缺陷检测结果进行比较分析,具有统计学意义。还检查了经皮刺激电压水平与患者BMI之间的关系。
结果：在除外展肌以外的所有肌肉中，TaMEP明显比TcMEP更可靠。在27个假阳性警报中，24只是TcMEP，只有3个是泰默。在19个真正的积极因素中，没有一个被TcMEP单独检测到，3只通过TaMEP检测到（不存在TcMEP），其余16个真阳性涉及TaMEP和TcMEP。在除外展肌以外的所有肌肉中,TaMEP在基线时具有比TcMEP显著更大的曲线下面积(AUC)。LLIF警报期间TcMEP和TaMEPAUC的百分比下降没有显着差异。TcMEP和TaMEP都反映了三个预先存在的运动缺陷。发现患者BMI和TaMEP刺激强度中等正相关。
结论：这些研究结果证明了TaMEP的高可靠性和可预测性，以及当TaMEP在腰骶部脊柱手术期间被纳入多模态IONM时潜在的附加价值。
目的：评估腰骶部脊柱手术期间经腹部运动诱发电位（TaMEPs）与TcMEPs相比的可靠性和有效性。
方法：我们介绍了使用由TcMEP组成的多模态术中神经监测（IONM）的所有腰骶骨脊柱手术的单中心12个月回顾性经验的发现，泰默,体感诱发电位（SSEP），肌电图（EMG）和脑电图。
方法：二百二十名患者，或腰骶脊柱手术的组合，包括腰椎前路椎间融合术（ALIF），腰椎外侧椎间融合术(LLIF),后路脊柱融合术(PSF),和/或经椎间孔腰椎椎间融合术（TLIF）。
方法：术中神经监测数据与术后即刻的神经系统检查和图表回顾相关。
方法：基线可靠性，假阳性率,真阳性率，假阴性率，基线和警报时曲线下的面积，并对TcMEPs和TaMEPs的术前缺陷检测结果进行比较分析,具有统计学意义。还检查了经皮刺激电压水平与患者BMI之间的关系。
结果：在除外展肌以外的所有肌肉中，TaMEP明显比TcMEP更可靠。在27个假阳性警报中，24只是TcMEP，只有3个是泰默。在19个真正的积极因素中，没有一个被TcMEP单独检测到，3只通过TaMEP检测到（不存在TcMEP），其余16个真阳性涉及TaMEP和TcMEP。在除外展肌以外的所有肌肉中,TaMEP在基线时具有比TcMEP显著更大的曲线下面积(AUC)。LLIF警报期间TcMEP和TaMEPAUC的百分比下降没有显着差异。TcMEP和TaMEP都反映了三个预先存在的运动缺陷。发现患者BMI和TaMEP刺激强度中等正相关。
结论：这些研究结果证明了TaMEP的高可靠性和可预测性，以及当TaMEP在腰骶部脊柱手术期间被纳入多模态IONM时潜在的附加价值。
