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Role of combined monitoring of TES-MEP and CSEP during spinal surgery and wake-up test in evaluating the spinal cord function

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Author:
No author available
Journal Title:
CHINESE JOURNAL OF BIOMEDICAL ENGINEERING
Issue:
1
DOI:
10.3760/cma.j.issn.1674-1927.2011.01.017
Key Word:
监测,手术中;经皮神经电刺激;诱发电位,运动;诱发电位,躯体感觉;唤醒试验;Monitoring,intraoperative;Transcutaneous electric nerve stimulation;Evoked Dotentials,motor;Evoked potentials,somatosensory;Wake-up test

Abstract´╝Ü Objective To explore the role of combined monitoring of transcranial electrical stimulation motor evoked potential (TES-MEP) and cortical somatosensory evoked potential (CSEP) during spinal surgery and wake-up test in evaluating the spinal cord function.Methods Between July 2006 and March 2010, combined intraoperative monitoring of TES-MEP and CSEP was performed in 426 patients registered to Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University.Moreover,wake-up tests were performed in 23 positive cases with causes unclear after a detailed workup or no recovery after modification of the surgery procedures.The post-operative spinal function was then compared between the combined monitoring and wake-up test, respectively.Results Sixty-four cases were found positive.Notably, fifty-one of them had consistent spinal function, and the remaining 13 cases were found inconsistent and false positive (3.1%, 13/426).No case with false negative results was found.The combined monitoring yielded 100%(51/51) sensitivity, 96.5%(362/375) specificity and a Youden index of 0.965.Of 23 wake-up tested cases, 8 positive cases were found with consistent spinal function, with no false positive cases found.However, of the remaining 15 negative cases, only 9 were found with consistent spinal function.The wake-up test yielded 100% (9/9) sensitivity, 57.1%(8/14) specificity and a Youden index of 0.571.Conclusions The combined monitoring of TES-MEP and CSEP is considered as an ideal alternative and a preferred method in monitoring the spinal function during surgery.Wake - up test can be used in verifying the results of combined monitoring.

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