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. 2023 Jun 30;12(13):4433.
doi: 10.3390/jcm12134433.

Factors Affecting Transcranial Motor-Evoked Potential Measurements Using Single-Train Stimulation with an Increased Number of Pulses during Adolescent Scoliosis Surgery: A Prospective Observational Study

Takayuki Toki  1 , Noriaki Fujita  1 , Tomohiro Ichikawa  2 , Noriki Ochi  2 , Isao Yokota  3 , Hideki Sudo  4 , Yuji Morimoto  1
Affiliations

Factors Affecting Transcranial Motor-Evoked Potential Measurements Using Single-Train Stimulation with an Increased Number of Pulses during Adolescent Scoliosis Surgery: A Prospective Observational Study

Takayuki Toki et al. J Clin Med. .

Abstract

Measurement of transcranial motor-evoked potentials (TcMEPs) during scoliosis surgery helps detect postoperative new neurological defects. However, TcMEP interpretation is difficult owing to the influence of intraoperative physiological, pharmacological, and time-related factors as well as stimulation conditions. In this study, we aimed to investigate the effect of the abovementioned factors on TcMEP amplitude using single-train stimulation with an increased number of pulses (STS-INP) during adolescent scoliosis surgery; moreover, we evaluated the complications of TcMEP measurement. We included 50 patients and 706 TcMEP measurements. A total of 1412 TcMEP waveforms were analyzed, each on the bilateral abductor pollicis brevis, tibialis anterior, and abductor hallucis muscles. We estimated the mean difference (95% confidence interval (CI)) and predicted mean difference (95% CI) evaluated using the interquartile range of each factor, based on a mixed-effect model with random intercepts for TcMEP amplitude. The predicted mean differences in TcMEP amplitude were clinically small compared with the actual TcMEP amplitude, suggesting that each factor had a limited effect on TcMEP amplitude. No intraoperative bite injuries or seizures were observed. Using STS-INP during adolescent scoliosis surgery may enable accurate measurement of TcMEP amplitude with neither complications nor the influence of various intraoperative factors.

Keywords: adolescent scoliosis; intraoperative neurological monitoring; transcranial motor-evoked potentials.

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Conflict of interest statement

The authors declare no conflict of interest related to this study.

Figures

Figure 1
Figure 1
Typical process of setting TcMEP stimulation conditions. First, we examined the number of pulses that produced the maximum amplitude. Subsequently, we searched for the stimulus intensity that produced the maximum amplitude, with the maximum stimulation output of 200 mA. Bold and underlined text indicates changes in stimulation conditions or the final setting. TcMEP—transcranial motor-evoked potential.
Figure 2
Figure 2
A picture with example of monitoring a patient.
Figure 3
Figure 3
Patient selection and TcMEP measurement flow chart. TcMEP—transcranial motor-evoked potential; BIS—bispectral index; SQI—signal quality index; EMG—electromyogram.
Figure 4
Figure 4
Typical transcranial motor-evoked potential waveform for the abductor pollicis brevis muscle with 13 pulse stimuli and an intensity of 160 mA. The amplitude is 3.53 mV.
See this image and copyright information in PMC

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