Evidence-based guideline update

intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials*.

Marc R. Nuwer, Ronald G. Emerson, Gloria Galloway, Alan D. Legatt, Jaime Lopez, Robert Minahan, Thoru Yamada, Douglas S. Goodin, Carmel Armon, Vinay Chaudhry, Gary S. Gronseth, Cynthia L. Harden, Association of Neuromuscular American Association of Neuromuscular

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

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).

Original languageEnglish (US)
Pages (from-to)101-108
Number of pages8
JournalJournal of clinical neurophysiology : official publication of the American Electroencephalographic Society
Volume29
Issue number1
StatePublished - Feb 2012

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Intraoperative Monitoring
Motor Evoked Potentials
Paraparesis
Quadriplegia
Paraplegia
Guidelines
Evoked Potentials
Nervous System
Spinal Cord

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Evidence-based guideline update : intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials*. / Nuwer, Marc R.; Emerson, Ronald G.; Galloway, Gloria; Legatt, Alan D.; Lopez, Jaime; Minahan, Robert; Yamada, Thoru; Goodin, Douglas S.; Armon, Carmel; Chaudhry, Vinay; Gronseth, Gary S.; Harden, Cynthia L.; American Association of Neuromuscular, Association of Neuromuscular.

In: Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society, Vol. 29, No. 1, 02.2012, p. 101-108.

Research output: Contribution to journalArticle

Nuwer, MR, Emerson, RG, Galloway, G, Legatt, AD, Lopez, J, Minahan, R, Yamada, T, Goodin, DS, Armon, C, Chaudhry, V, Gronseth, GS, Harden, CL & American Association of Neuromuscular, AON 2012, 'Evidence-based guideline update: intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials*.', Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society, vol. 29, no. 1, pp. 101-108.
Nuwer, Marc R. ; Emerson, Ronald G. ; Galloway, Gloria ; Legatt, Alan D. ; Lopez, Jaime ; Minahan, Robert ; Yamada, Thoru ; Goodin, Douglas S. ; Armon, Carmel ; Chaudhry, Vinay ; Gronseth, Gary S. ; Harden, Cynthia L. ; American Association of Neuromuscular, Association of Neuromuscular. / Evidence-based guideline update : intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials*. In: Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2012 ; Vol. 29, No. 1. pp. 101-108.
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AU - Lopez, Jaime

AU - Minahan, Robert

AU - Yamada, Thoru

AU - Goodin, Douglas S.

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AU - Chaudhry, Vinay

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AU - Harden, Cynthia L.

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