Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis

Tun Liu; Liang Yan; Huaguang Qi; Zhenguo Luo; Xuemei Liu; Tao Yuan; Buhuai Dong; Yuanting Zhao; Songchuan Zhao; Houkun Li; Zhian Liu; Xucai Wu; Fei Wang; Wentao Wang; Yunfei Huang; Gang Wang

doi:10.3389/fnins.2022.879435

Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis

Front Neurosci. 2022 Jun 10:16:879435. doi: 10.3389/fnins.2022.879435. eCollection 2022.

Authors

Tun Liu¹, Liang Yan², Huaguang Qi³, Zhenguo Luo¹, Xuemei Liu³, Tao Yuan³, Buhuai Dong¹, Yuanting Zhao², Songchuan Zhao², Houkun Li², Zhian Liu⁴, Xucai Wu¹, Fei Wang⁵, Wentao Wang², Yunfei Huang², Gang Wang⁴

Affiliations

¹ Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.
² Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.
³ Department of Functional Inspection Section, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.
⁴ The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi'an Jiaotong University, Xi'an, China.
⁵ Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.

Abstract

Background: Intraoperative neuromonitoring (IONM) has become an increasingly essential technique in spinal surgery. However, data on the diagnostic value of IONM in predicting impending postoperative neurological deficits (PONDs) for patients who underwent posterior decompression surgery for thoracic spinal stenosis (TSS) are limited. Furthermore, patients who are at the highest risk of waveform changes during the surgery remain unknown. Our purpose was to (1) assess the diagnostic accuracy of IONM by combining somatosensory-evoked potential (SSEP) with motor-evoked potential (MEP) in predicting PONDs for patients who underwent the surgery and (2) identify the independent risk factors correlated with IONM changes in our study population.

Methods: A total of 326 consecutive patients who underwent the surgery were identified and analyzed. We collected the following data: (1) demographic and clinical data; (2) IONM data; and (3) outcome data such as details of PONDs, and recovery status (complete, partial, or no recovery) at the 12-month follow-up visit.

Results: In total, 27 patients developed PONDs. However, 15, 6, and 6 patients achieved complete recovery, partial recovery, and no recovery, respectively, at the 12-month follow-up. SSEP or MEP change monitoring yielded better diagnostic efficacy in predicting PONDs as indicated by the increased sensitivity (96.30%) and area under the receiver operating characteristic (ROC) curve (AUC) value (0.91). Only one neurological deficit occurred without waveform changes. On multiple logistic regression analysis, the independent risk factors associated with waveform changes were as follows: preoperative moderate or severe neurological deficits (p = 0.002), operating in the upper- or middle-thoracic spinal level (p = 0.003), estimated blood loss (EBL) ≥ 400 ml (p < 0.001), duration of symptoms ≥ 3 months (p < 0.001), and impairment of gait (p = 0.001).

Conclusion: Somatosensory-evoked potential or MEP change is a highly sensitive and moderately specific indicator for predicting PONDs in posterior decompression surgery for TSS. The independent risks for IONM change were as follows: operated in upper- or middle-thoracic spinal level, presented with gait impairment, had massive blood loss, moderate or severe neurological deficits preoperatively, and had a longer duration of symptoms.

Clinical trial registration: [http://www.chictr.org.cn]; identifier [ChiCTR 200003 2155].

Keywords: intraoperative neuromonitoring; motor-evoked potential; postoperative neurological deficits; somatosensory-evoked potential; thoracic spinal stenosis.