Intraoperative Motor Evoked Potential Improvement in Cervical Spondylotic Myelopathy: Comparison of Cortical Stimulation Parameters
10.3988/jcn.2020.16.1.102
- Author:
Yew Long LO
1
;
Lisa ZHU
;
Reuben C SOH
;
Chang Ming GUO
Author Information
1. Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore. lo.yew.long@singhealth.com.sg
- Publication Type:Original Article
- From:Journal of Clinical Neurology
2020;16(1):102-107
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND:AND PURPOSE: Intraoperative monitoring of the motor pathways is a routine procedure for ensuring the integrity of descending motor tracts during spinal surgery. Intraoperative motor evoked potential improvement (MEPI) may be associated with a better postsurgical outcome in cervical spondylotic myelopathy (CSM). To compare the efficacy of two cortical stimulation parameters in eliciting MEPI intraoperatively during CSM surgery.
METHODS:We studied 69 patients who underwent decompression surgery for CSM over a 9-month period using either 5 (Group 1) or 9 (Group 2) stimuli. MEPI was defined as the increase in the amplitude of MEPs from baseline at the end of CSM surgery just prior to skin closure.
RESULTS:An MEPI of 100% from baseline was observed in 10 patients (53%) in Group 1 and 36 patients (72%) in Group 2. Comparisons of the baseline mean MEP amplitudes of muscles bilaterally between Groups 1 and 2 did not reveal any significant differences. Supramaximal stimulation showed that a significantly higher mean intensity was required for Group 1 than for Group 2.
CONCLUSIONS:MEPI is observed in a much larger proportion of cervical decompression surgery cases than previously thought. Intraoperative MEPI with longer-train cortical stimulation may reflect adequacy of decompression and provide additional guidance for the surgical procedure.
