title: Transcranial electric motor evoked potential monitoring during spine surgery: is it safe?
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To report on the safety of repetitive transcranial electric stimulation (RTES) for eliciting motor-evoked potentials during spine surgery.
  
  
  BACKGROUND
  Theoretical concerns over the safety of RTES have hindered broader acceptance of transcranial electric motor-evoked potentials (tceMEP), despite successful implementation of spinal cord monitoring with tceMEPs in many large spine centers, as well as their apparent superiority over mixed-nerve somatosensory-evoked potentials (SSEP) for detection of spinal cord injury.
  
  
  METHODS
  The records of 18,862 consecutive patients who met inclusion criteria and underwent spine surgery with tceMEP monitoring were reviewed for RTES-related complications.
  
  
  RESULTS
  This large retrospective review identified only 26 (0.14%) cases with RTES-related complications; all but one of these were tongue lacerations, most of which were self-limiting.
  
  
  CONCLUSIONS
  The results demonstrate that RTES is a highly safe modality for monitoring spinal cord motor tract function intraoperatively.
authors.affiliation: Surgical Monitoring Associates, Springfield, PA 19064, USA. dan@surgmon.com
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Schwartz
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Sestokas
authors.forename: John P
authors.initials: JP
authors.lastname: Dormans
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.forename: P Mark
authors.initials: PM
authors.lastname: Li
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
authors.forename: William
authors.initials: W
authors.lastname: Welch
authors.forename: Denis S
authors.initials: DS
authors.lastname: Drummond
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D007223:Infant; D022125:Lacerations; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000379:methods*; D019637:Orthopedic Procedures / Q000009:adverse effects; D015143:Philadelphia; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000209:etiology; D013131:Spine / Q000601:surgery*; D014059:Tongue / Q000293:injuries; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects; D055815:Young Adult