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Comparative Study
. 2018 Jul 5:13:1211-1218.
doi: 10.2147/CIA.S163467. eCollection 2018.

The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy

Min Kyu Park  1 , Sook Joung Lee  2 , Sang Beom Kim  3 , Kyeong Woo Lee  3 , Hye-Jeong Lee  4 , Eun Young Han  5 , Bo Ryun Kim  5
Affiliations
Comparative Study

The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy

Min Kyu Park et al. Clin Interv Aging. .

Abstract

Background: Cervical compressive myelopathy (CCM) is a progressive, degenerative spine disease and the most common cause of spinal cord dysfunction in older individuals. Current clinical guidelines for spinal surgery recommend multimodal intraoperative monitoring (IOM) during spinal surgery as a reliable and valid diagnostic adjunct to assess spinal cord integrity. The aim of this study was to evaluate the effect of positive changes during IOM on the functional status in patients with CCM.

Methods: Patients who underwent spinal surgery with IOM due to CCM were enrolled. During the surgery, patients underwent IOM using motor evoked potential (MEP) and somatosensory evoked potential (SEP). MEP and SEP were checked before and immediately after decompression. A decrease in latency >10% or an increase in amplitude >50% was regarded as a "positive changes". Subjects were divided according to the presence of positive changes. Motor scores of American Spinal Injury Association (ASIA) impairment scale and Korean version of Modified Barthel Index (K-MBI) were evaluated before and after operation.

Results: Twenty-nine patients underwent spinal surgery due to CCM. Eleven patients showed positive changes in MEP during IOM. When the two groups were compared, improvement rate in the ASIA motor score and K-MBI were significantly higher in patients with positive changes than in patients without positive changes at 1 month after surgery. However, 6 months after surgery, there were no significance differences between the groups. Regardless of positive change, nearly all patients suffered from neuropathic pain after operation.

Conclusion: Positive changes in MEP during IOM may affect functional improvement 1 month after operation and early discharge without significant complications in CCM patients. However, they do not affect the neuropathic pain and long-term functional outcome. Thus, tailored proper management is needed to achieve maximal functional recovery in each patient after cervical spinal decompression surgery.

Keywords: cervical myelopathy; degenerative disorder; function; intraoperative monitoring; positive change.

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Conflict of interest statement

Disclosure MK Park was supported by the Dong-A University research fund (No. 2013-2-01). The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
A case with a “positive change” (A) and a case with “warning sign” after decompression (B) during IOM. Abbreviations: Abs, absolute; Div, dividend; IOM, intraoperative monitoring.
Figure 2
Figure 2
Functional changes according to time in both groups. Notes: In the positive change group, the ASIA motor scale showed significant improvement with time after operation relative to that before operation. However, the no positive change group displayed a slight decrease in motor score at 1 month after operation relative to that before operation, but the motor score recovered at 6 months after operation (A). K-MBI also decreased at 1 month after operation relative to that before operation, but it recovered and improved much at 6 months after operation in both groups (B). Abbreviations: ASIA, American Spinal Injury Association; K-MBI, Korean version of Modified Barthel Index; Preop, preoperative; Postop, postoperative.
Figure 3
Figure 3
Functional improvement rates in both groups. Notes: Comparison of improvement rates between the two groups indicated significantly higher ASIA motor score and K-MBI score in patients in the positive change group than in patients in the no positive change group. At one month after surgery, ASIA and K-MBI showed significant improvement rate in the positive change group. But six months after surgery, ASIA and K-MBI showed no significant differences between groups. Abbreviations: ASIA, American Spinal Injury Association; K-MBI, Korean version of Modified Barthel Index; btw, between; postop, postoperative; preop, preoperative.
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References

    1. Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Wang JC. A clinical practice guideline for the management of degenerative cervical myelopathy: introduction, rationale, and scope. Global Spine J. 2017;7(3 Suppl):21S–27S. - PMC - PubMed
    1. Lubelski D, Alvin MD, Nesterenko S, et al. Correlation of quality of life and functional outcome measures for cervical spondylotic myelopathy. J Neurosurg Spine. 2016;24(3):483–489. - PubMed
    1. Devlin VJ, Schwartz DM. Intraoperative neurophysiologic monitoring during spinal surgery. J Am Acad Orthop Surg. 2007;15(9):549–560. - PubMed
    1. Tamaki T, Kubota S. History of the development of intraoperative spinal cord monitoring. Eur Spine J. 2007;16(Suppl 2):S140–S146. - PMC - PubMed
    1. Hadley MN, Shank CD, Rozzelle CJ, Walters BC. Guidelines for the use of electrophysiological monitoring for surgery of the human spinal column and spinal cord. Neurosurgery. 2017;81(5):713–732. - PubMed

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