Skip to main content
Log in

Improving successful rate of transcranial electrical motor-evoked potentials monitoring during spinal surgery in young children

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Introduction

This prospective study was to investigate the successful rate of intraoperative motor evoked potentials (MEP) monitoring for children (<12 years old) with congenital scoliosis.

Materials and methods

A consecutive series of 27 young children (7 girls and 20 boys; from 1 to 11 years old) between September 2007 and November 2009, were enrolled to this study. 12 patients received general anesthesia based on TIVA, induced with propofol 2–4 mg/kg and fentanyl 3–5 µg/kg followed by a continuous infusion of propofol (20–150 µg/kg/min, at mean of 71.7 µg/kg/min). The other 15 patients received combined inhalation and intravenous anesthesia, induced with sevoflurane and fentanyl 3–5 µg/kg and maintained by sevoflurane (0.5–1%). The maintenance of anaesthesia management was performed with stable physiological parameters during surgery.

Results

Intraoperative MEP monitoring was successfully performed in all patients, while SEP was successfully performed in 26 of 27 patients. There was no significant difference of successful rates between SEP and MEP monitoring (P > 0.05). As well, no difference in MEP successful rates was observed in two groups with different anesthetic techniques. No wake-up test and no post-operative neurological deficits occurred in this series of patients.

Conclusion

Low dose anesthesia by either TIVA with propofol or sevoflurane-based mixture anesthesia protocol can help the intraoperative spinal cord monitoring to successfully elicit MEP and perform reliable monitoring for patients below 12 years of age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dawson EG, Sherman JE, Kanim LE et al (1991) Spinal cord monitoring. Results of the Scoliosis Research Society and the European Spinal Deformity Society survey. Spine 16:S361–S364

    Article  PubMed  CAS  Google Scholar 

  2. Devlin V (2003) Intraoperative spinal monitoring. In: Spine secrets. Hanley & Belfus Inc., Philadelphia, pp 232–242.

  3. Nuwer MR, Dawson EG, Carlson LG et al (1995) Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 96:6–11

    Article  PubMed  CAS  Google Scholar 

  4. Lo YL, Dan YF, Tan YE et al (2005) A prospective study of the utility of preoperative somatosensory evoked potentials in spinal surgery. Eur Spine J 14:521–522

    Article  PubMed  CAS  Google Scholar 

  5. Gonzalez AA, Jeyanandarajan D, Hansen C et al (2009) Intraoperative neurophysiological monitoring during spine surgery: a review. Neurosurg Focus 27(4):E6

    Article  PubMed  Google Scholar 

  6. Calancie B, Harris W, Brindle GF et al (2001) Threshold-level repetitive transcranial electrical stimulation for intraoperative monitoring of central motor conduction. J Neurosurg Spine 95:161–168

    Article  CAS  Google Scholar 

  7. Kombos T, Kopetsch O, Suess O et al (2003) Does preoperative paresis influence intraoperative monitoring of the motor cortex? J Clin Neurophysiol 20:129–134

    Article  PubMed  Google Scholar 

  8. Kombos T, Suess O, Ciklatekerlio O et al (2001) Monitoring of intraoperative motor evoked potentials to increase the safety of surgery in and around the motor cortex. J Neurosurg 95:608–614

    Article  PubMed  CAS  Google Scholar 

  9. Pechstein U, Cedzich C, Nadstawek J et al (1996) Transcranial high-frequency repetitive electrical stimulation for recording myogenic motor evoked potentials with the patient under general anesthesia. Neurosurgery 39:335–343

    Google Scholar 

  10. Pelosi L, Stevenson M, Hobbs GJ et al (2001) Intraoperative motor evoked potentials to transcranial electrical stimulation during two anaesthetic regimens. Clin Neurophysiol 112:1076–1087

    Article  PubMed  CAS  Google Scholar 

  11. Scheufler KM, Reinacher PC, Blumrich W et al (2005) The modifying effects of stimulation pattern and propofol plasma concentration on motor-evoked potentials. Anesth Analg 100:440–447

    Article  PubMed  CAS  Google Scholar 

  12. Zhou HH, Kelly PJ (2001) Transcranial electrical motor evoked potential monitoring for brain tumor resection. Neurosurgery 48:1075–1080

    Article  PubMed  CAS  Google Scholar 

  13. Chen X, Sterio D, Ming X et al (2007) Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deficits. J Clin Neurophysiol 24(3):281–285

    Article  PubMed  Google Scholar 

  14. Frei FJ, Ryhult SE, Duitmann E et al (2007) Intraoperative monitoring of motor-evoked potentials in children undergoing spinal surgery. Spine 32(8):911–917

    Article  PubMed  Google Scholar 

  15. Vitale MG, Moore DW, Matsumoto H et al (2010) Risk factors for spinal cord injury during surgery for spinal deformity. J Bone Joint Surg Am 92(1):64–71

    Article  PubMed  Google Scholar 

  16. Coe JD, Arlet V, Donaldson W et al (2006) Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine 31:345–349

    Article  PubMed  Google Scholar 

  17. Skaggs DL, Choi PD, Rice C et al (2009) Efficacy of intraoperative neurologic monitoring in surgery involving a vertical expandable prosthetic titanium rib for early-onset spinal deformity. J Bone Joint Surg Am 91:1657–1663

    Article  PubMed  Google Scholar 

  18. Boor R, Li L, Goebel B et al (2008) Subcortical somatosensory evoked potentials after posterior tibial nerve stimulation in children. Brain Dev 30:493–498

    Article  PubMed  Google Scholar 

  19. Journee HL, Polak HE, De Kleuver M (2007) Conditioning stimulation techniques for enhancement of transcranially elicited evoked motor responses. Neurophysiol Clin 37:423–430

    Article  PubMed  Google Scholar 

  20. Kalkman CJ, Drummond JC, Ribberink AA (1991) Low concentrations of isoflurane abolish motor evoked responses to transcranial electrical stimulation during nitrous oxide/opioid anesthesia in humans. Anesth Analg 73:410–415

    Article  PubMed  CAS  Google Scholar 

  21. Magit DP, Hilibrand AS, Kirk J et al (2007) Questionnaire study of neuromonitoring availability and usage for spine surgery. J Spinal Disord Tech 20:282–289

    Article  PubMed  Google Scholar 

  22. Sloan TB, Janik D, Jameson L (2008) Multimodality monitoring of the central nervous system using motor-evoked potentials. Curr Opin Anaesthesiol 21:560–564

    Article  PubMed  Google Scholar 

  23. Kawaguchi M, Sakamoto T, Inoue S et al (2000) Low dose propofol as a supplement to ketamine-based anesthesia during intraoperative monitoring of motor-evoked potentials. Spine 25:974–979

    Article  PubMed  CAS  Google Scholar 

  24. Davidson AJ (2007) Monitoring the anaesthetic depth in children—an update. Curr Opin Anaesthesiol 20(3):236–243

    Article  PubMed  Google Scholar 

  25. Weber F, Hollnberger H, Weber J (2008) Electroencephalographic Narcotrend Index monitoring during procedural sedation and analgesia in children. Paediatr Anaesth 18(9):823–830

    Article  PubMed  Google Scholar 

  26. Schultz B, Grouven U, Schultz A (2002) Automatic classification algorithms of the EEG monitor Narcotrend for routinely recorded EEG data from general anesthesia: a validation study. Biomed Tech (Berl) 47:9–13

    Article  CAS  Google Scholar 

  27. Felmet K, Nguyen T, Clark RS et al (2003) The FDA warning against prolonged sedation with propofol in children remains warranted. Pediatrics 112(4):1002–1003

    Article  PubMed  Google Scholar 

  28. Lyon R, Feiner J, Lieberman JA (2005) Progressive suppression of motor evoked potentials during general anesthesia: the phenomenon of “anesthetic fade”. J Neurosurg Anesthesiol 17:13–19

    PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yong Hu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yang, J., Huang, Z., Shu, H. et al. Improving successful rate of transcranial electrical motor-evoked potentials monitoring during spinal surgery in young children. Eur Spine J 21, 980–984 (2012). https://doi.org/10.1007/s00586-011-1995-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-011-1995-z

Keywords

Navigation