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Transcranial Motor-evoked Potential Alert After Supine-to-Prone Position Change During Thoracic Ossification in Posterior Longitudinal Ligament Surgery
- Source :
- Spine. 47:1018-1026
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Study design A prospective, multicenter study. Objective To evaluate the usefulness of transcranial motor-evoked potentials (Tc-MEPs) during supine-to-prone position change for thoracic ossification of the posterior longitudinal ligament (T-OPLL). Summary of background data Supine-to-prone position change might be a risk of spinal cord injury in posterior decompression and fusion surgeries for T-OPLL. Methods The subjects were 145 patients with T-OPLL surgically treated with posterior decompression and fusion using Tc-MEPs in 14 institutes. Tc-MEPs were monitored before surgery from supine-to-prone position and intraoperatively in 7 institutes and only intraoperatively in the other 7 institutes because of disapproval of the anesthesia department. In cases of Tc-MEP alert after position change, we adjusted the cervicothoracic posture. When the MEP did not recover, we reverted the position to supine and monitored the Tc-MEPs in supine position. Results There were 83 and 62 patients with/without Tc-MEP before position change to prone (group A and B). The true-positive rate was lower in group A than group B, but without statistical significance (8.4% vs 16.1%, p = 0.12). In group A, 5 patients who had Tc-MEP alert during supine-to-prone position change were all female and had larger body mass index values and upper thoracic lesions. Among the patients, 3 underwent surgeries after cervicothoracic alignment adjustment, and 2 had postponed operations to 1 week later with halo-vest fixation because of repeated Tc-MEP alerts during position change to prone. The Tc-MEP alert at exposure was statistically more frequent in group B than in group A (p = 0.033). Conclusion Tc-MEP alert during position change is an important sign of spinal cord injury due to alignment change at the upper thoracic spine. Tc-MEP monitoring before supine-to-prone position change was necessary to prevent spinal cord injury in surgeries for T-OPLL.Level of Evidence: 4.
- Subjects :
- medicine.medical_specialty
Supine position
Ossification of Posterior Longitudinal Ligament
Thoracic Vertebrae
Japan
Osteogenesis
Prone Position
medicine
Humans
Posterior longitudinal ligament
Orthopedics and Sports Medicine
Prospective Studies
Evoked potential
Spinal cord injury
Spinal Cord Injuries
Fixation (histology)
Ossification
business.industry
Decompression, Surgical
Evoked Potentials, Motor
medicine.disease
Longitudinal Ligaments
Surgery
Prone position
Position (obstetrics)
Spinal Fusion
Female
Neurology (clinical)
medicine.symptom
business
Subjects
Details
- ISSN :
- 03622436
- Volume :
- 47
- Database :
- OpenAIRE
- Journal :
- Spine
- Accession number :
- edsair.doi.dedup.....b2856f532376499c0a11e34aa2ce3a45