Stimulation parameters for motor evoked potentials during intraoperative spinal cord monitoring. A systematic review

Abstract

Objective: The aim of this systematic review was to find the optimal stimulation parameters for muscle recorded transcranial electrical stimulation motor evoked potential (mTc-MEP) and D-wave monitoring during spinal cord monitoring.

Methods: A PRISMA systematic search in Medline and EMBASE and a QUADAS-2 quality evaluation was performed to identify studies that compared stimulation parameters consisting of stimulation location, number of pulses, pulse duration, interstimulus interval, double train (DTS) or recurrent train stimulation (RTS) and intertrain interval (ITI) for performing mTc-MEP and D-wave monitoring. Only studies that used total intravenous anaesthesia (TIVA) were included.

Results: Ten studies that compared stimulation parameters for performing mTc-MEP monitoring (stimulation location n = 4, number of pulses n = 2, pulse duration n = 1, interstimulus interval n = 4, DTS n = 1, RTS n = 2, ITI n = 2) were included. No studies compared stimulation parameters (stimulation location and pulse duration) for performing D-wave monitoring.

Conclusions: Few studies examined the optimal stimulation parameters for monitoring mTc-MEPs and no studies were included for D-wave monitoring. There is a need for prospective research to investigate the optimal stimulation parameters for mTc-MEP with the use of TIVA and D-wave monitoring.

Significance: For mTc-MEP monitoring, a table is provided in which the recommended stimulation parameters are stated.

Keywords: Direct-waves (D-waves); Intraoperative neurophysiological monitoring (IONM); Muscle recorded transcranial electrical stimulation motor evoked potentials (mTc-MEPs); Stimulation method; Stimulation parameters; Total intravenous anaesthesia (TIVA).