title: Predicting intraoperative feasibility of combined TES-mMEP and cSSEP monitoring during scoliosis surgery based on preoperative neurophysiological assessment.
abstract: BACKGROUND
  Combined monitoring of muscle motor evoked potentials elicited by transcranial electric stimulation (TES-mMEP) and cortical somatosensory evoked potentials (cSSEPs) is safe and effective for spinal cord monitoring during scoliosis surgery. However, TES-mMEP/cSSEP is not always feasible. Predictors of feasibility would help to plan the monitoring strategy.
  
  
  OBJECTIVE
  To identify predictors of the feasibility of TES-mMEP/cSSEP during scoliosis surgery.
  
  
  METHODS
  Prospective cohort study in a clinical neurophysiology unit and pediatric orthopedic department of a French university hospital.
  
  
  METHODS
  A total of 103 children aged 2 to 19 years scheduled for scoliosis surgery.
  
  
  METHODS
  Feasibility rate of intraoperative TES-mMEP/cSSEP monitoring.
  
  
  METHODS
  All patients underwent a preoperative neurological evaluation and preoperative mMEP and cSSEP recordings at both legs. For each factor associated with feasibility, we computed sensitivity, specificity, positive predictive value (PPV), and negative predictive value. A decision tree was designed.
  
  
  RESULTS
  Presence of any of the following factors was associated with 100% feasibility, 100% specificity, and 100% PPV: idiopathic scoliosis, normal preoperative neurological findings, and normal preoperative mMEP and cSSEP recordings. Feasibility was 0% in the eight patients with no recordable mMEPs or cSSEPs during preoperative testing. A decision tree involving three screening steps can be used to identify patients in whom intraoperative TES-mMEP/cSSEP is feasible.
  
  
  CONCLUSIONS
  Preoperative neurological and neurophysiological assessments are helpful for identifying patients who can be successfully monitored by TES-mMEP/cSSEP during scoliosis surgery.
authors.affiliation: Physiology Department, Hôpital Raymond Poincaré, Assistance Publique- Hôpitaux de Paris, EA 4497-Group for Clinical and Technical Research on Disability, INSERM CIC-IT 805, University of Versailles St Quentin, 104 Bd Raymond Poincaré, 92380 Garches, France; Epilepsy Sleep and Paediatric Neurophysiology Department, Hôpital Femme Mère Enfant et Hôpital Neurologique, HCL, University of Lyon 1, 59 Bd Pinel, 69003 Lyon, France; Intraoperative Neurophysiology Department, Institute for Neurology and Neurosurgery, St-Luke Roosevelt Hospital, 1000 Tenth Ave., New York, NY 10019, USA. Electronic address: eric.azabou@rpc.ap-hop-paris.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Azabou
authors.affiliation: Epilepsy Sleep and Paediatric Neurophysiology Department, Hôpital Femme Mère Enfant et Hôpital Neurologique, HCL, University of Lyon 1, 59 Bd Pinel, 69003 Lyon, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Manel
authors.affiliation: Paediatric Orthopaedic Surgery Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University of Lyon 1, 59 Bd Pinel, 69003 Lyon, France.
authors.forename: Kariman
authors.initials: K
authors.lastname: Abelin-Genevois
authors.affiliation: Epilepsy Sleep and Paediatric Neurophysiology Department, Hôpital Femme Mère Enfant et Hôpital Neurologique, HCL, University of Lyon 1, 59 Bd Pinel, 69003 Lyon, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Andre-Obadia
authors.affiliation: Paediatric Orthopaedic Surgery Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University of Lyon 1, 59 Bd Pinel, 69003 Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Cunin
authors.affiliation: Paediatric Orthopaedic Surgery Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University of Lyon 1, 59 Bd Pinel, 69003 Lyon, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Garin
authors.affiliation: Paediatric Orthopaedic Surgery Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University of Lyon 1, 59 Bd Pinel, 69003 Lyon, France.
authors.forename: Remi
authors.initials: R
authors.lastname: Kohler
authors.affiliation: Paediatric Orthopaedic Surgery Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University of Lyon 1, 59 Bd Pinel, 69003 Lyon, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Berard
authors.affiliation: Intraoperative Neurophysiology Department, Institute for Neurology and Neurosurgery, St-Luke Roosevelt Hospital, 1000 Tenth Ave., New York, NY 10019, USA.
authors.forename: Sedat
authors.initials: S
authors.lastname: Ulkatan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D012600:Scoliosis / Q000503:physiopathology / Q000601:surgery*; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000503:physiopathology*; D065908:Transcranial Direct Current Stimulation; D055815:Young Adult
keywords: Decision tree; Feasibility; Intraoperative monitoring; Motor evoked potentials; Planning; Preoperative procedures; Scoliosis; Somatosensory evoked potentials; Surgery