title: Multimodal intraoperative monitoring (MIOM) during surgical decompression of thoracic spinal stenosis in 36 patients.
abstract: A prospective study of 36 patients who received multimodal intraoperative monitoring (MIOM) during decompression of thoracic spinal stenosis between March 2000 and December 2005 was chosen as the study design. The objective was to determine the sensitivity and specificity of MIOM techniques used for monitoring spinal cord during surgical thoracic decompression. The background data revealed that the surgical decompression for thoracic spinal stenosis is less frequent than in other regions of the spine. However, due to the relative narrow spinal canal, neurological complications could be severe. The combination of monitoring ascending and descending pathways may provide an early alert to the surgeon in order to alter the surgical procedure, and avoid neurological complications. The methods involved evaluation of intraoperative somatosensory spinal and cerebral evoked potentials and motor evoked potentials of the spinal cord and muscles that were compared with post operative clinical neurological changes. 36 consecutive patients with thoracic spinal stenosis of different aetiologies were monitored by the means of MIOM during the surgical procedure. 31 patients had true negative while one patient had false positive findings. Three patients had true positive and one patient had false negative findings. This indicates a sensitivity of 75% and a specificity of 97%. The one case of false negative findings recovered completely within 3 months. In conclusion, the MIOM is an effective method of monitoring the spinal cord during surgical decompression of the thoracic spine.
authors.affiliation: Department of Neurology/Spine Unit, Schulthess Clinic, Lengghalde 2, 8008, Zürich, Switzerland. Andreas.Eggspuehler@kws.ch
authors.forename: Andreas
authors.initials: A
authors.lastname: Eggspuehler
authors.forename: Martin A
authors.initials: MA
authors.lastname: Sutter
authors.forename: Dieter
authors.initials: D
authors.lastname: Grob
authors.forename: F
authors.initials: F
authors.lastname: Porchet
authors.forename: Dezsö
authors.initials: D
authors.lastname: Jeszenszky
authors.forename: Jiri
authors.initials: J
authors.lastname: Dvorak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013130:Spinal Stenosis / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*