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Wada K, Imagama S, Matsuyama Y, Yoshida G, Ando K, Kobayashi K, Machino M, Kawabata S, Iwasaki H, Funaba M, Kanchiku T, Yamada K, Fujiwara Y, Shigematsu H, Taniguchi S, Ando M, Takahashi M, Ushirozako H, Tadokoro N, Morito S, Yamamoto N, Yasuda A, Hashimoto J, Takatani T, Tani T, Kumagai G, Asari T, Nitobe Y, Ishibashi Y. Comparison of intraoperative neuromonitoring accuracies and procedures associated with alarms in anterior versus posterior fusion for cervical spinal disorders: A prospective multi-institutional cohort study. Medicine (Baltimore) 2022; 101:e31846. [PMID: 36626536 PMCID: PMC9750642 DOI: 10.1097/md.0000000000031846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A prospective multicenter cohort study. To clarify the differences in the accuracy of transcranial motor-evoked potentials (TcE-MEPs) and procedures associated with the alarms between cervical anterior spinal fusion (ASF) and posterior spinal fusion (PSF). Neurological complications after TcE-MEP alarms have been prevented by appropriate interventions for cervical degenerative disorders. The differences in the accuracy of TcE-MEPs and the timing of alarms between cervical ASF and PSF noted in the existing literature remain unclear. Patients (n = 415) who underwent cervical ASF (n = 171) or PSF (n = 244) at multiple institutions for cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, spinal injury, and others were analyzed. Neurological complications, TcE-MEP alarms defined as a decreased amplitude of ≤70% compared to the control waveform, interventions after alarms, and TcE-MEP results were compared between the 2 surgeries. The incidence of neurological complications was 1.2% in the ASF group and 2.0% in the PSF group, with no significant intergroup differences (P-value was .493). Sensitivity, specificity, negative predictive value, and rate of rescue were 50.0%, 95.2%, 99.4%, and 1.8%, respectively, in the ASF group, and 80.0%, 90.9%, 99.5%, and 2.9%, respectively, in the PSF group. The accuracy of TcE-MEPs was not significantly different between the 2 groups (P-value was .427 in sensitivity, .109 in specificity, and .674 in negative predictive value). The procedures associated with the alarms were decompression in 3 cases and distraction in 1 patient in the ASF group. The PSF group showed Tc-MEPs decreased during decompression, mounting rods, turning positions, and others. Most alarms went off during decompression in ASF, whereas various stages of the surgical procedures were associated with the alarms in PSF. There were no significant differences in the accuracy of TcE-MEPs between the 2 surgeries.
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Affiliation(s)
- Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigenori Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University, Yamaguchi, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan
| | - Kei Yamada
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | | | - Muneharu Ando
- Department of Orthopedic Surgery, Kansai Medical University, Osaka, Japan
| | | | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Nobuaki Tadokoro
- Department of Orthopedic Surgery, Kochi University, Kochi, Japan
| | - Shinji Morito
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Naoya Yamamoto
- Department of Orthopedic Surgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
| | - Akimasa Yasuda
- Department of Orthopedic Surgery, National Defense Medical College Hospital, Saitama, Japan
| | - Jun Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tunenori Takatani
- Department of Central Operation, Nara Medical University, Nara, Japan
| | - Toshikazu Tani
- Department of Orthopedic Surgery, Kubokawa Hospital, Kochi, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshiro Nitobe
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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