Usefulness of multi-channels in intraoperative spinal cord monitoring: multi-center study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research

Abstract

Object: The purpose of this study is to analyze the data in terms of the number of channels employed to examine the usefulness of multi-channels in intraoperative spinal cord monitoring.

Methods: The prerequisites for inclusion in the baseline data were as follows: (1) cases in which only CMAP monitoring was conducted; (2) cases in which monitoring was conducted under the same stimulation condition and the recording condition. Cases where inhalation anesthesia was used or muscle relaxants were used as maintenance anesthesia was excluded from the baseline data. Of the 6,887 cases, 884 cases met the criteria. The items examined for each of the different numbers of channels were the sensitivity and specificity, the false positive rate, the false negative rate, and the coverage rate of postoperative motor deficit muscles.

Result: To examine these two items in terms of the number of channels, the 4-channel group had lower sensitivity and specificity scores compared with the 8- and 16-channel groups (4 channels 73/93 %, 8 channels 100/97 %, 16 channels 100/95 %). Only four channels were derived for these cases and the coverage of postoperative motor deficit muscles was 38 % with only 30 out of the 80 postoperative motor deficit muscles in total being monitored. In the 8-channel group, it was 60 % with 12 of the 20 postoperative motor deficit muscles being monitored. The 16-channel group had 100 % coverage rate of postoperative motor deficit muscles.

Conclusion: We suggest that multi-channel monitoring of at least eight channels is desirable for intraoperative spinal cord monitoring.

Fig. 1

The flowchart of the subjects of this study and the condition of stimulation and recording and the breakdown and number for true positive and false negative cases

Fig. 2

The coverage rate of postoperative motor deficit muscles