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Buhl LK, Bastos AB, Pollard RJ, Arle JE, Thomas GP, Song Y, Boone MD. Neurophysiologic Intraoperative Monitoring for Spine Surgery: A Practical Guide From Past to Present. J Intensive Care Med 2020; 36:1237-1249. [PMID: 32985340 DOI: 10.1177/0885066620962453] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraoperative neuromonitoring was introduced in the second half of the 20th century with the goal of preventing patient morbidity for patients undergoing complex operations of the central and peripheral nervous system. Since its early use for scoliosis surgery, the growth and utilization of IOM techniques expanded dramatically over the past 50 years to include spinal tumor resection and evaluation of cerebral ischemia. The importance of IOM has been broadly acknowledged, and in 1989, the American Academy of Neurology (AAN) released a statement that the use of SSEPs should be standard-of-care during spine surgery. In 2012, both the AAN and the American Clinical Neurophysiology Society (ACNS) recommended that: "Intraoperative monitoring (IOM) using SSEPs and transcranial MEPs be established as an effective means of predicting an increased risk of adverse outcomes, such as paraparesis, paraplegia, and quadriplegia, in spinal surgery." With a multimodal approach that combines SSEPs, MEPs, and sEMG with tEMG and D waves, as appropriate, sensitivity and specificity can be maximized for the diagnosis of reversible insults to the spinal cord, nerve roots, and peripheral nerves. As with most patient safety efforts in the operating room, IOM requires contributions from and communication between a number of different teams. This comprehensive review of neuromonitoring techniques for surgery on the central and peripheral nervous system will highlight the technical, surgical and anesthesia factors required to optimize outcomes. In addition, this review will discuss important trouble shooting measures to be considered when managing ION changes concerning for potential injury.
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Affiliation(s)
- Lauren K Buhl
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andres Brenes Bastos
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Richard J Pollard
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeffrey E Arle
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - George P Thomas
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Yinchen Song
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - M Dustin Boone
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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CASTRO CAÍQUEJAUHARDE, SILVA LUISEDUARDOCARELLITEIXEIRADA, ALMEIDA LUIZEDUARDO, BARROS ALDERICOGIRÃOCAMPOSDE, VITAL ROBSONTEIXEIRA, JARDIM MÁRCIAMARIARODRIGUES, FONSECA GIULIANAVASCONCELOSDESOUZA. INTRA- AND INTEROBSERVER ANALYSIS OF PEDICLE SCREW PLACEMENT IN SCOLIOSIS CORRECTION. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201903224255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
ABSTRACT Objective To establish the statistical interobserver and intraobserver concordance of thoracic pedicle screw placement in scoliosis surgery, with a 4-week interval between the two analyses. Methods Of 55 patients that evaluated the intra- and interobserver concordances of the screw positions (according to the Abul-Kasim classification) using the Kappa coefficient. Results The intraobserver concordance ranged from a Kappa coefficient of 0.516 to 0.889 (“moderate” to “almost perfect”) between the two analyses performed four weeks apart. Interobserver concordance ranged from 0.379 to 0.633 (“reasonable” to “strong”). Conclusion The intraobserver concordance was always greater than the interobserver concordance. No concordance coefficient was classified as “insignificant” or “weak”. Level of Evidence III; Retrospective study.
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Affiliation(s)
| | - LUIS EDUARDO CARELLI TEIXEIRA DA SILVA
- Instituto Nacional de Traumatologia e Ortopedia, Brazil; Instituto da Coluna Vertebral do Rio de Janeiro, Brazil; Universidade Federal do Estado do Rio de Janeiro, Brazil
| | - LUIZ EDUARDO ALMEIDA
- Instituto Nacional de Traumatologia e Ortopedia, Brazil; Instituto da Coluna Vertebral do Rio de Janeiro, Brazil
| | | | - ROBSON TEIXEIRA VITAL
- Instituto Nacional de Traumatologia e Ortopedia, Brazil; Universidade Federal do Estado do Rio de Janeiro, Brazil
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