Monitoring of scoliosis surgery with epidurally recorded motor evoked potentials (D wave) revealed false results
To elucidate the mechanism behind D wave amplitude changes after surgical correction of scoliosis. We collected D wave and muscle MEP data from 93 patients (78 female, 15 male, age range 4–19 years, mean age 15.9 years), who underwent surgical correction of scoliosis. D waves were recorded via a cat...
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| Veröffentlicht in: | Clinical neurophysiology 2006-09, Vol.117 (9), p.2093-2101 |
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| creator | Ulkatan, S. Neuwirth, M. Bitan, F. Minardi, C. Kokoszka, A. Deletis, V. |
| description | To elucidate the mechanism behind D wave amplitude changes after surgical correction of scoliosis.
We collected D wave and muscle MEP data from 93 patients (78 female, 15 male, age range 4–19 years, mean age 15.9 years), who underwent surgical correction of scoliosis. D waves were recorded via a catheter electrode inserted epidurally through the flavectomy. Muscle MEPs from lower limb muscles were also recorded. Muscle MEPs/D wave were elicited by short trains/single transcranial electrical stimuli. SEPs were elicited through bilateral percutaneous stimulation of the tibial nerves at the ankle and an averaged response from 100 to 200 single sweeps were recorded over the scalp at Cz’/Fz.
In addition, we analyzed intraoperatively obtained X-ray images of the spine in 9 patients and preoperative spinal MRI in two of those nine.
After surgical correction of scoliosis in 25 of 93 (27%) patients, the D wave amplitude changed by more than 20% of its baseline value. A decremental change occurred in 21 (84%) and an incremental change in 4 (16%) patients. D wave decrements of more than 50% were observed in 5 patients without significant SEP changes in any of these cases. In 9 patients, intraoperatively obtained X-rays of the spine (before and after correction of spine curvature) showed no catheter displacement. Muscle MEPs did not change and postoperative sensory-motor status was normal. In 2 patients, preoperative MRI revealed displacement of the spinal cord towards the concave side of the scoliotic curvature.
During scoliosis surgery, D wave amplitude changes should be interpreted cautiously until the definitive cause(s) of these changes are found. One possible mechanism to explain D wave changes during scoliosis correction could involve rotation of the spinal cord within the spinal canal, and the relative position of the epidural recording catheter (ERC). Rotation of the spinal cord after correction of scoliosis could introduce a new relationship between the ERC and the corticospinal tracts (CTs). Due to high incidence of false D wave amplitude changes we suggest that this methodology should not be used to assess the functional integrity of the CTs during scoliosis surgery.
This study provides new insight into the methodology of D wave monitoring as well as strong evidence of a high incidence of false positive results using D wave monitoring during surgical correction of scoliosis. |
| doi_str_mv | 10.1016/j.clinph.2006.05.021 |
| format | Article |
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We collected D wave and muscle MEP data from 93 patients (78 female, 15 male, age range 4–19 years, mean age 15.9 years), who underwent surgical correction of scoliosis. D waves were recorded via a catheter electrode inserted epidurally through the flavectomy. Muscle MEPs from lower limb muscles were also recorded. Muscle MEPs/D wave were elicited by short trains/single transcranial electrical stimuli. SEPs were elicited through bilateral percutaneous stimulation of the tibial nerves at the ankle and an averaged response from 100 to 200 single sweeps were recorded over the scalp at Cz’/Fz.
In addition, we analyzed intraoperatively obtained X-ray images of the spine in 9 patients and preoperative spinal MRI in two of those nine.
After surgical correction of scoliosis in 25 of 93 (27%) patients, the D wave amplitude changed by more than 20% of its baseline value. A decremental change occurred in 21 (84%) and an incremental change in 4 (16%) patients. D wave decrements of more than 50% were observed in 5 patients without significant SEP changes in any of these cases. In 9 patients, intraoperatively obtained X-rays of the spine (before and after correction of spine curvature) showed no catheter displacement. Muscle MEPs did not change and postoperative sensory-motor status was normal. In 2 patients, preoperative MRI revealed displacement of the spinal cord towards the concave side of the scoliotic curvature.
During scoliosis surgery, D wave amplitude changes should be interpreted cautiously until the definitive cause(s) of these changes are found. One possible mechanism to explain D wave changes during scoliosis correction could involve rotation of the spinal cord within the spinal canal, and the relative position of the epidural recording catheter (ERC). Rotation of the spinal cord after correction of scoliosis could introduce a new relationship between the ERC and the corticospinal tracts (CTs). Due to high incidence of false D wave amplitude changes we suggest that this methodology should not be used to assess the functional integrity of the CTs during scoliosis surgery.
This study provides new insight into the methodology of D wave monitoring as well as strong evidence of a high incidence of false positive results using D wave monitoring during surgical correction of scoliosis.</description><identifier>ISSN: 1388-2457</identifier><identifier>EISSN: 1872-8952</identifier><identifier>DOI: 10.1016/j.clinph.2006.05.021</identifier><identifier>PMID: 16844406</identifier><language>eng</language><publisher>Shannon: Elsevier Ireland Ltd</publisher><subject>Action Potentials - physiology ; Adolescent ; Adult ; Analysis of Variance ; Biological and medical sciences ; Child ; D wave ; Electric Stimulation - methods ; Electrodiagnosis. Electric activity recording ; Electromyography - methods ; Epidural Space ; Evoked Potentials, Motor - physiology ; Female ; Fundamental and applied biological sciences. Psychology ; Humans ; Intra operative monitoring ; Investigative techniques, diagnostic techniques (general aspects) ; Magnetic Resonance Imaging - methods ; Male ; Medical sciences ; Monitoring, Intraoperative ; Motor evoked potentials ; Muscle, Skeletal - physiopathology ; Nervous system ; Reaction Time - physiology ; Reaction Time - radiation effects ; Scoliosis - physiopathology ; Scoliosis - radiotherapy ; Scoliosis - surgery ; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors ; Tomography, X-Ray Computed - methods ; Vertebrates: nervous system and sense organs</subject><ispartof>Clinical neurophysiology, 2006-09, Vol.117 (9), p.2093-2101</ispartof><rights>2006</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-29540af365898105bd072064ecb1e764d3b4f4b5ad45f4a7386358c16d1f32dd3</citedby><cites>FETCH-LOGICAL-c390t-29540af365898105bd072064ecb1e764d3b4f4b5ad45f4a7386358c16d1f32dd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.clinph.2006.05.021$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18136583$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16844406$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ulkatan, S.</creatorcontrib><creatorcontrib>Neuwirth, M.</creatorcontrib><creatorcontrib>Bitan, F.</creatorcontrib><creatorcontrib>Minardi, C.</creatorcontrib><creatorcontrib>Kokoszka, A.</creatorcontrib><creatorcontrib>Deletis, V.</creatorcontrib><title>Monitoring of scoliosis surgery with epidurally recorded motor evoked potentials (D wave) revealed false results</title><title>Clinical neurophysiology</title><addtitle>Clin Neurophysiol</addtitle><description>To elucidate the mechanism behind D wave amplitude changes after surgical correction of scoliosis.
We collected D wave and muscle MEP data from 93 patients (78 female, 15 male, age range 4–19 years, mean age 15.9 years), who underwent surgical correction of scoliosis. D waves were recorded via a catheter electrode inserted epidurally through the flavectomy. Muscle MEPs from lower limb muscles were also recorded. Muscle MEPs/D wave were elicited by short trains/single transcranial electrical stimuli. SEPs were elicited through bilateral percutaneous stimulation of the tibial nerves at the ankle and an averaged response from 100 to 200 single sweeps were recorded over the scalp at Cz’/Fz.
In addition, we analyzed intraoperatively obtained X-ray images of the spine in 9 patients and preoperative spinal MRI in two of those nine.
After surgical correction of scoliosis in 25 of 93 (27%) patients, the D wave amplitude changed by more than 20% of its baseline value. A decremental change occurred in 21 (84%) and an incremental change in 4 (16%) patients. D wave decrements of more than 50% were observed in 5 patients without significant SEP changes in any of these cases. In 9 patients, intraoperatively obtained X-rays of the spine (before and after correction of spine curvature) showed no catheter displacement. Muscle MEPs did not change and postoperative sensory-motor status was normal. In 2 patients, preoperative MRI revealed displacement of the spinal cord towards the concave side of the scoliotic curvature.
During scoliosis surgery, D wave amplitude changes should be interpreted cautiously until the definitive cause(s) of these changes are found. One possible mechanism to explain D wave changes during scoliosis correction could involve rotation of the spinal cord within the spinal canal, and the relative position of the epidural recording catheter (ERC). Rotation of the spinal cord after correction of scoliosis could introduce a new relationship between the ERC and the corticospinal tracts (CTs). Due to high incidence of false D wave amplitude changes we suggest that this methodology should not be used to assess the functional integrity of the CTs during scoliosis surgery.
This study provides new insight into the methodology of D wave monitoring as well as strong evidence of a high incidence of false positive results using D wave monitoring during surgical correction of scoliosis.</description><subject>Action Potentials - physiology</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Analysis of Variance</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>D wave</subject><subject>Electric Stimulation - methods</subject><subject>Electrodiagnosis. Electric activity recording</subject><subject>Electromyography - methods</subject><subject>Epidural Space</subject><subject>Evoked Potentials, Motor - physiology</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Intra operative monitoring</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Monitoring, Intraoperative</subject><subject>Motor evoked potentials</subject><subject>Muscle, Skeletal - physiopathology</subject><subject>Nervous system</subject><subject>Reaction Time - physiology</subject><subject>Reaction Time - radiation effects</subject><subject>Scoliosis - physiopathology</subject><subject>Scoliosis - radiotherapy</subject><subject>Scoliosis - surgery</subject><subject>Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Vertebrates: nervous system and sense organs</subject><issn>1388-2457</issn><issn>1872-8952</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMuOFCEYhYnROBd9A2PYaHRRJfeiNpOYcbwkY9zomlDw1wwtXZRQ1ZN-e2m7k9m5ggPf-QMfQq8oaSmh6sOmdTFM833LCFEtkS1h9Ak6p7pjje4le1r3XOuGCdmdoYtSNoSQjgj2HJ1RpYUQRJ2j-XuawpJymO5wGnFxKYZUQsFlzXeQ9_ghLPcY5uDXbGPc4wwuZQ8eb1OtYdil3zXMaYFpCTYW_O4TfrA7eF_JHdhYL8d6DDWWNS7lBXr2L788rZfo1-ebn9dfm9sfX75df7xtHO_J0rBeCmJHrqTuNSVy8KRjRAlwA4VOCc8HMYpBWi_kKGzHteJSO6o8HTnznl-it8e5c05_ViiL2YbiIEY7QVqLUbrruWaiguIIupxKyTCaOYetzXtDiTmYNhtzNG0Opg2Rppqutden-euwBf9YOqmtwJsTYIuzccx2cqE8cpoePscrd3XkoNrYBcimuACTAx-q68X4FP7_kr8pQp-g</recordid><startdate>20060901</startdate><enddate>20060901</enddate><creator>Ulkatan, S.</creator><creator>Neuwirth, M.</creator><creator>Bitan, F.</creator><creator>Minardi, C.</creator><creator>Kokoszka, A.</creator><creator>Deletis, V.</creator><general>Elsevier Ireland Ltd</general><general>Elsevier Science</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20060901</creationdate><title>Monitoring of scoliosis surgery with epidurally recorded motor evoked potentials (D wave) revealed false results</title><author>Ulkatan, S. ; Neuwirth, M. ; Bitan, F. ; Minardi, C. ; Kokoszka, A. ; Deletis, V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-29540af365898105bd072064ecb1e764d3b4f4b5ad45f4a7386358c16d1f32dd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Action Potentials - physiology</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Analysis of Variance</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>D wave</topic><topic>Electric Stimulation - methods</topic><topic>Electrodiagnosis. Electric activity recording</topic><topic>Electromyography - methods</topic><topic>Epidural Space</topic><topic>Evoked Potentials, Motor - physiology</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Intra operative monitoring</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Monitoring, Intraoperative</topic><topic>Motor evoked potentials</topic><topic>Muscle, Skeletal - physiopathology</topic><topic>Nervous system</topic><topic>Reaction Time - physiology</topic><topic>Reaction Time - radiation effects</topic><topic>Scoliosis - physiopathology</topic><topic>Scoliosis - radiotherapy</topic><topic>Scoliosis - surgery</topic><topic>Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Vertebrates: nervous system and sense organs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ulkatan, S.</creatorcontrib><creatorcontrib>Neuwirth, M.</creatorcontrib><creatorcontrib>Bitan, F.</creatorcontrib><creatorcontrib>Minardi, C.</creatorcontrib><creatorcontrib>Kokoszka, A.</creatorcontrib><creatorcontrib>Deletis, V.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neurophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ulkatan, S.</au><au>Neuwirth, M.</au><au>Bitan, F.</au><au>Minardi, C.</au><au>Kokoszka, A.</au><au>Deletis, V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Monitoring of scoliosis surgery with epidurally recorded motor evoked potentials (D wave) revealed false results</atitle><jtitle>Clinical neurophysiology</jtitle><addtitle>Clin Neurophysiol</addtitle><date>2006-09-01</date><risdate>2006</risdate><volume>117</volume><issue>9</issue><spage>2093</spage><epage>2101</epage><pages>2093-2101</pages><issn>1388-2457</issn><eissn>1872-8952</eissn><abstract>To elucidate the mechanism behind D wave amplitude changes after surgical correction of scoliosis.
We collected D wave and muscle MEP data from 93 patients (78 female, 15 male, age range 4–19 years, mean age 15.9 years), who underwent surgical correction of scoliosis. D waves were recorded via a catheter electrode inserted epidurally through the flavectomy. Muscle MEPs from lower limb muscles were also recorded. Muscle MEPs/D wave were elicited by short trains/single transcranial electrical stimuli. SEPs were elicited through bilateral percutaneous stimulation of the tibial nerves at the ankle and an averaged response from 100 to 200 single sweeps were recorded over the scalp at Cz’/Fz.
In addition, we analyzed intraoperatively obtained X-ray images of the spine in 9 patients and preoperative spinal MRI in two of those nine.
After surgical correction of scoliosis in 25 of 93 (27%) patients, the D wave amplitude changed by more than 20% of its baseline value. A decremental change occurred in 21 (84%) and an incremental change in 4 (16%) patients. D wave decrements of more than 50% were observed in 5 patients without significant SEP changes in any of these cases. In 9 patients, intraoperatively obtained X-rays of the spine (before and after correction of spine curvature) showed no catheter displacement. Muscle MEPs did not change and postoperative sensory-motor status was normal. In 2 patients, preoperative MRI revealed displacement of the spinal cord towards the concave side of the scoliotic curvature.
During scoliosis surgery, D wave amplitude changes should be interpreted cautiously until the definitive cause(s) of these changes are found. One possible mechanism to explain D wave changes during scoliosis correction could involve rotation of the spinal cord within the spinal canal, and the relative position of the epidural recording catheter (ERC). Rotation of the spinal cord after correction of scoliosis could introduce a new relationship between the ERC and the corticospinal tracts (CTs). Due to high incidence of false D wave amplitude changes we suggest that this methodology should not be used to assess the functional integrity of the CTs during scoliosis surgery.
This study provides new insight into the methodology of D wave monitoring as well as strong evidence of a high incidence of false positive results using D wave monitoring during surgical correction of scoliosis.</abstract><cop>Shannon</cop><pub>Elsevier Ireland Ltd</pub><pmid>16844406</pmid><doi>10.1016/j.clinph.2006.05.021</doi><tpages>9</tpages></addata></record> |
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| subjects | Action Potentials - physiology Adolescent Adult Analysis of Variance Biological and medical sciences Child D wave Electric Stimulation - methods Electrodiagnosis. Electric activity recording Electromyography - methods Epidural Space Evoked Potentials, Motor - physiology Female Fundamental and applied biological sciences. Psychology Humans Intra operative monitoring Investigative techniques, diagnostic techniques (general aspects) Magnetic Resonance Imaging - methods Male Medical sciences Monitoring, Intraoperative Motor evoked potentials Muscle, Skeletal - physiopathology Nervous system Reaction Time - physiology Reaction Time - radiation effects Scoliosis - physiopathology Scoliosis - radiotherapy Scoliosis - surgery Somesthesis and somesthetic pathways (proprioception, exteroception, nociception) interoception electrolocation. Sensory receptors Tomography, X-Ray Computed - methods Vertebrates: nervous system and sense organs |
| title | Monitoring of scoliosis surgery with epidurally recorded motor evoked potentials (D wave) revealed false results |
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