title: Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery.
abstract: BACKGROUND
  The vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia.
  
  
  OBJECTIVE
  The goal of this study was to evaluate a novel method of intraoperative testing of a nerve root's contribution to the blood supply of the thoracic spinal cord.
  
  
  METHODS
  This is a clinical retrospective study of 49 patients diagnosed with thoracic spine tumors. Temporary nerve root clipping combined with motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring was performed; additionally, postoperative clinical evaluation was done and reported in all cases.
  
  
  METHODS
  All cases were monitored by SSEP and MEPs. The nerve root to be sacrificed was temporarily clipped using standard aneurysm clips, and SSEP/MEP were assessed before and after clipping. Four nerve roots were sacrificed in four cases, three nerve roots in eight cases, and two nerve roots in 22 cases. Nerve roots were sacrificed bilaterally in 12 cases.
  
  
  RESULTS
  Most patients (47/49) had no changes in MEP/SSEP and had no neurological deficit postoperatively. One case of a spinal sarcoma demonstrated changes in MEP after temporary clipping of the left T11 nerve root. The nerve was not sacrificed, and the patient was neurologically intact after surgery. In another case of a sarcoma, MEPs changed in the lower limbs after ligation of left T9 nerve root. It was felt that it was a global event because of anesthesia. Postoperatively, the patient had complete paraplegia but recovered almost completely after 6 months.
  
  
  CONCLUSIONS
  Temporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome.
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program, University of South Florida College of Medicine, Tampa, FL 33612, USA.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Eleraky
authors.forename: Matthias
authors.initials: M
authors.lastname: Setzer
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Papanastassiou
authors.forename: Ali A
authors.initials: AA
authors.lastname: Baaj
authors.forename: Nam D
authors.initials: ND
authors.lastname: Tran
authors.forename: Kiesha M
authors.initials: KM
authors.lastname: Katsares
authors.forename: Frank D
authors.initials: FD
authors.lastname: Vrionis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D013116:Spinal Cord / Q000098:blood supply*; D013125:Spinal Neoplasms / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000502:physiology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery