期刊
JOURNAL OF CLINICAL NEUROPHYSIOLOGY
卷 29, 期 1, 页码 101-108出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/WNP.0b013e31824a397e
关键词
Intraoperative monitoring; Somatosensory evoked potentials; Motor evoked potentials; Outcome studies; Spinal cord
资金
- American Academy of Neurology
- American Clinical Neurophysiology Society
- Bristol-Myers Squibb
- Cyberkinetics Neurotechnology Systems Inc.
- National Institutes of Health
- NYS SCIRB
- Epilepsy Foundation
- Cadwell Laboratories, Inc.
- Bayer Schering Pharma
- Teva Pharmaceutical Industries Ltd.
- Novartis
- Merck Serono
- Avanir Pharmaceuticals
- Schwartz Biomedical, LLC
- Swiss PFO-Consortium
- Neuropathy Association
- Nutricia
- Forest Laboratories, Inc.
- Milken Family Foundation
Objective: To evaluate whether spinal cord intraoperative monitoring (IOM) with somatosensory and transcranial electrical motor evoked potentials (EPs) predict adverse surgical outcomes. Methods: A panel of experts reviewed the results of a comprehensive literature search and identified published studies relevant to the clinical question. These studies were classified according to the evidence-based methodology of the American Academy of Neurology. Objective outcomes of postoperative onset of paraparesis, paraplegia, and quadriplegia were used because no randomized or masked studies were available. Results and Recommendations: Four class I and eight class II studies met inclusion criteria for analysis. The four class I studies and seven of the eight class II studies reached significance in showing that paraparesis, paraplegia, and quadriplegia occurred in the IOM patients with EP changes compared with the IOM group without EP change. All studies were consistent in showing all occurrences of paraparesis, paraplegia, and quadriplegia in the IOM patients with EP changes, with no occurrences of paraparesis, paraplegia, and quadriplegia in patients without EP change. In the class I studies, 16% to 40% of the IOM patients with EP changes developed postoperative-onset paraparesis, paraplegia, or quadriplegia. IOM is established as effective to predict an increased risk of the adverse outcomes of paraparesis, paraplegia, and quadriplegia in spinal surgery (four class I and seven class II studies). Surgeons and other members of the operating team should be alerted to the increased risk of severe adverse neurologic outcomes in patients with important IOM changes (level A).
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