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The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1,017 patients

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Abstract

A prospective study of 1,017 patients who received MIOM during spine surgery procedures between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve roots function during spine surgery. MIOM has become a widely used method of monitoring neural function during spine surgery. Several techniques only monitor either ascending or descending pathways and thus may not provide sensitive or specific results. MIOM aims to monitor both ascending and descending pathways therefore giving immediate feedback information regarding any neurological deficits during the operation. Intraoperative sensory spinal and cortical evoked potentials, combined with monitoring of EMG and motor evoked potentials recorded from the spinal cord and muscles elicited by electrical motor cortex, spinal cord, cauda equina and nerve root stimulation, was evaluated and compared with post-operative clinical neurological changes. One thousand and seventeen consecutive patients underwent a total of 4,731 h of MIOM to evaluate any neural deficits that may have occurred during spine surgery. Of these, 935 were true negative cases, 8 were false negative cases, 66 were true positive cases and 8 were false positive cases, resulting in a sensitivity of 89% and a specificity of 99%. Based on the results of this study, MIOM is an effective method of monitoring the spinal cord functional integrity during spine surgery and therefore can lead to reduction of neurological deficit and consequently improve postoperative results.

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Abbreviations

cm-EP:

Cerebro-muscular evoked potentials

cs-EP:

Cerebro-spinal evoked potentials

ns-EP:

Neuro-spinal evoked potentials

nc-EP:

Neuro-cerebral evoked potentials

sm-EP:

Spino-muscular evoked potentials

ss-EP:

Spino-spinal evoked potentials

BCR:

Bulbo-cavernosus reflex

BAR:

Bulbo-anal reflex

AEP:

Acoustic evoked potentials

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Acknowledgments

Dr. Lote Medicus fund for the financial support of the development of MIOM at the Schulthess Clinic. Dave O’Riordan and Charles McCammon for helping with the manuscript. Anne Mannion PhD for the critical review of the manuscript.

Conflict of interest statement None of the authors has any potential conflict of interest.

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Authors and Affiliations

  1. Department of Neurology/Spine Unit, Schulthess Clinic, Lengghalde 2, 8008, Zürich, Switzerland

    Martin Sutter, Andreas Eggspuehler, Alfred Mueller & Jiri Dvorak

  2. Department of Orthopedic Surgery, Schulthess Clinic, Lengghalde 2, 8008, Zürich, Switzerland

    Dieter Grob & Dezsoe Jeszenszky

  3. Department of Neurosurgery, Schulthess Clinic, Lengghalde 2, 8008, Zürich, Switzerland

    Arnaldo Benini & François Porchet

Authors
  1. Martin Sutter
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  2. Andreas Eggspuehler
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  3. Dieter Grob
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  4. Dezsoe Jeszenszky
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  5. Arnaldo Benini
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  6. François Porchet
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  7. Alfred Mueller
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  8. Jiri Dvorak
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Correspondence to Martin Sutter.

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Sutter, M., Eggspuehler, A., Grob, D. et al. The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1,017 patients. Eur Spine J 16 (Suppl 2), 162–170 (2007). https://doi.org/10.1007/s00586-007-0418-7

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  • DOI: https://doi.org/10.1007/s00586-007-0418-7

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