Comparison of Motor Evoked Potentials Neuromonitoring Following Pre- and Postoperative Transcranial Magnetic Stimulation and Intraoperative Electrical Stimulation in Patients Undergoing Surgical Correction of Idiopathic Scoliosis

J. Clin. Med., 2023 · DOI: 10.3390/jcm12196312 · Published: September 30, 2023

Simple Explanation

This study compares motor evoked potential (MEP) recordings before, during, and after surgery for idiopathic scoliosis (IS) to see if surgery improves spinal cord function. The study involved 353 girls with IS, examining electromyography (EMG), electroneurography (ENG), and motor evoked potentials (MEP) of the tibialis anterior muscle. The research aimed to determine if MEP recordings from transcranial magnetic stimulation (TMS) and electrical stimuli (TES) could be compared to verify spinal cord neural transmission improvement during surgery.

Study Duration

Not specified

Participants

353 girls with right idiopathic scoliosis

Evidence Level

Not specified

Key Findings

1
MEP recordings using TMS indicated a slight improvement in efferent neural transmission in IS patients after surgery, showing better nerve signal flow.
2
Neurophysiological studies showed asymmetry in IS patients, with worse recordings on the concave side, suggesting greater neurological motor deficits, which reduced post-surgery.
3
ENG results showed axonal-type injury symptoms in peroneal motor fibers, improving only on the concave side post-surgery, suggesting lumbar ventral roots are decompressed.

Research Summary

The study investigated the relationship between pre- and intraoperative motor evoked potential recordings and the effect of surgical correction on spinal efferent transmission in idiopathic scoliosis (IS) patients. Results indicated a slight improvement in efferent neural transmission postoperatively, with asymmetry in neurophysiological studies reduced after surgery. The findings suggest that surgeries might directly result in additional lumbar ventral root decompression, highlighting the importance of stable anesthesia during neuromonitoring.

Practical Implications

Improved Neuromonitoring

Pre- and intraoperative MEP recordings are reliable for evaluating neurological status during scoliosis correction.

Surgical Outcome Prediction

MEP parameter changes, influenced by surgery procedures, can reduce false-positive neuromonitoring warnings.

Enhanced Post-operative Care

Surgeries may decompress lumbar ventral roots, improving motor function in patients with IS.

Study Limitations

1
Analysis limited to MEP recordings from the tibialis anterior muscle.
2
Further studies needed to confirm long-term effects of scoliosis surgery on motor function.
3
The exact reasons for transient latency changes during surgery remain unknown.

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