Intraoperative monitoring of motor evoked potentials: A review of 116 cases

K. J. Nagle, R. G. Emerson, David C. Adams, E. J. Heyer, D. P. Roye, F. J. Schwab, M. Weidenbaum, P. McCormick, J. Pile-Spellman, B. M. Stein, J. P. Farcy, E. J. Gallo, K. C. Dowling, C. A. Turner

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

We reviewed the results of motor evoked potential (MEP) and somatosensory evoked potential (SEP) monitoring during 116 operations on the spine or spinal cord. We monitored MEPs by electrically stimulating the spinal cord and recording compound muscle action potentials from lower extremity muscles and monitored SEPs by stimulating posterior tibial or peroneal nerves and recording both cortical and subcortical evoked potentials. We maintained anesthesia with an N2O/O2/opioid technique supplemented with a halogenated inhalational agent and maintained partial neuromuscular blockade using a vecuronium infusion. Both MEPs and SEPs could be recorded in 99 cases (85%). Neither MEPs nor SEPs were recorded in eight patients, all of whom had preexisting severe myelopathies. Only SEPs could be recorded in two patients, and only MEPs were obtained in seven cases. Deterioration of evoked potentials occurred during nine operations (8%). In eight cases, both SEPs and MEPs deteriorated; in one case, only MEPs deteriorated. In four cases, the changes in the monitored signals led to major alterations in the surgery. We believe that optimal monitoring during spinal surgery requires recording both SEPs and MEPs. This provides independent verification of spinal cord integrity using two parallel but independent systems, and also allows detection of the occasional insults that selectively affect either motor or sensory systems.

Original languageEnglish (US)
Pages (from-to)999-1004
Number of pages6
JournalNeurology
Volume47
Issue number4
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

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Intraoperative Monitoring
Motor Evoked Potentials
Spinal Cord
Evoked Potentials
Vecuronium Bromide
Muscles
Tibial Nerve
Peroneal Nerve
Neuromuscular Blockade
Somatosensory Evoked Potentials
Spinal Cord Diseases
Opioid Analgesics
Action Potentials
Lower Extremity
Spine
Anesthesia

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Nagle, K. J., Emerson, R. G., Adams, D. C., Heyer, E. J., Roye, D. P., Schwab, F. J., ... Turner, C. A. (1996). Intraoperative monitoring of motor evoked potentials: A review of 116 cases. Neurology, 47(4), 999-1004. https://doi.org/10.1212/WNL.47.4.999

Intraoperative monitoring of motor evoked potentials : A review of 116 cases. / Nagle, K. J.; Emerson, R. G.; Adams, David C.; Heyer, E. J.; Roye, D. P.; Schwab, F. J.; Weidenbaum, M.; McCormick, P.; Pile-Spellman, J.; Stein, B. M.; Farcy, J. P.; Gallo, E. J.; Dowling, K. C.; Turner, C. A.

In: Neurology, Vol. 47, No. 4, 01.01.1996, p. 999-1004.

Research output: Contribution to journalArticle

Nagle, KJ, Emerson, RG, Adams, DC, Heyer, EJ, Roye, DP, Schwab, FJ, Weidenbaum, M, McCormick, P, Pile-Spellman, J, Stein, BM, Farcy, JP, Gallo, EJ, Dowling, KC & Turner, CA 1996, 'Intraoperative monitoring of motor evoked potentials: A review of 116 cases', Neurology, vol. 47, no. 4, pp. 999-1004. https://doi.org/10.1212/WNL.47.4.999
Nagle KJ, Emerson RG, Adams DC, Heyer EJ, Roye DP, Schwab FJ et al. Intraoperative monitoring of motor evoked potentials: A review of 116 cases. Neurology. 1996 Jan 1;47(4):999-1004. https://doi.org/10.1212/WNL.47.4.999
Nagle, K. J. ; Emerson, R. G. ; Adams, David C. ; Heyer, E. J. ; Roye, D. P. ; Schwab, F. J. ; Weidenbaum, M. ; McCormick, P. ; Pile-Spellman, J. ; Stein, B. M. ; Farcy, J. P. ; Gallo, E. J. ; Dowling, K. C. ; Turner, C. A. / Intraoperative monitoring of motor evoked potentials : A review of 116 cases. In: Neurology. 1996 ; Vol. 47, No. 4. pp. 999-1004.
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