Are There False-Negative and False-Positive Motor-Evoked Potentials?

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Abstract

Abstracts of Reviewed Articles

False-Negative Transcranial Motor-Evoked Potentials During Scoliosis Surgery Causing Paralysis: A Case Report With Literature Review

Abstracts of Reviewed Articles

Modi HN, Suh S-W, Yang J-H, Yoon J-Y

Abstracts of Reviewed Articles

Spine 2009;34:E896–E900

Abstracts of Reviewed Articles

Study Design: Case report.

Abstracts of Reviewed Articles

Objective: To report a case of false-negative intraoperative motor-evoked potentials (MEP) that developed paraplegia after surgery.

Abstracts of Reviewed Articles

Summary of Background Data: Although several false-negative results have been reported with somatosensory-evoked potentials, there is no report noted with MEP. Therefore, several authors have preferred using MEPs as a gold standard in neuromonitoring.

Abstracts of Reviewed Articles

Methods: We report a case of false-negative MEP during the scoliosis surgery which is the first report showing false-negative MEPs during operation.

Abstracts of Reviewed Articles

Results: A 15-year-old girl with severe kyphoscoliosis (Cobb angle, 140°) in neurofibromatosis was operated for correction and posterior spinal fusion surgery, using pedicle screw instrumentation. Intraoperative neuromonitoring did not show any change in MEPs throughout the procedure, however, she woke-up with paraplegia. Immediate implant release could not recover her neurology functionally at last follow-up. Positive event during the operation was massive blood loss which could not show drop in MEPs as an ischemic cord injury (probable cause). Postoperative CT scan in both patients did not show any injury with pedicle screw as implants were well placed within the pedicles. Reviewing the literature, we could not find out any prospective study in animals identifying false-negative results with MEPs.

Abstracts of Reviewed Articles

Conclusion: From our experience of false-negative MEPs, we conclude that unwanted events with use of MEP in scoliosis or other spinal surgeries. We propose further prospective research on animals to solve this issue.

Abstracts of Reviewed Articles

False Negative and Positive Motor Evoked Potentials in One Patient: Is Single Motor Evoked Potential Monitoring Reliable Method?: A Case Report and Literature Review

Abstracts of Reviewed Articles

Hong J-H, Suh S-W, Modi HN, Hur C-Y, Song H-R, Park JH

Abstracts of Reviewed Articles

Spine 2010;35:E912–E916

Abstracts of Reviewed Articles

Study Design: A case report and literature review.

Abstracts of Reviewed Articles

Objective: To report a false negative and delayed positive motor-evoked potential (MEP) in 1 patient.

Abstracts of Reviewed Articles

Summary of Background Data: An unreliable MEP can result in fatal outcomes because surgeons have recently begun to depend on the MEP for intraoperative decision-making.

Abstracts of Reviewed Articles

Methods: We report a case of a false MEP during scoliosis surgery that showed false negative and positive MEPs during a series of operations.

Abstracts of Reviewed Articles

Results: A 23-year-old man with a history of spondyloepiphyseal dysplasia presented with severe kyphoscoliosis. The initial neurologic examination did not reveal any neurologic abnormalities. Surgical correction and fusion were performed with transcranial MEP monitoring. During the entire procedure, the MEP did not reveal any signs of cord injury. However, lower limb paralysis and paresthesia was observed when the patient awakened. After 2 additional surgical procedures to recover the neurologic deficit, the MEP did not show any signs of cord injury but the patient's neurologic status had recovered slightly. At postoperative day 8, the neurologic status recovered, and a third operation was performed to fix the long rods. However, there were abnormal amplitudes in both lower limbs but the patient's neurologic status was almost normal.

Abstracts of Reviewed Articles

Conclusion: From our experience of false negative and positive MEP in 1 patient, it is concluded that undesirable events can occur with use of MEP in scoliosis or other spinal surgery. Therefore, we warn the surgeons too heavily rely on the MEP monitoring, and propose a further prospective study as well as use of alternative method that can improve the reliability of single MEP.

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