Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis

摘要: Transcranial motor-evoked potentials (TcMEPs) are used to monitor the descending motor pathway during scoliosis surgery. By comparing before and after correction, surgeons may prevent postoperative functional loss in distal muscles. There is currently no consensus as which muscles should be monitored. The purpose of this study determine least invasive monitoring protocol with best localization potential neurologic deficit. A retrospective review 125 patients TcMEP surgery for thoracolumbar between 2008 2015 was conducted. 18 had consult due remaining 107 were a consecutive cohort without consult. TcMEPs recorded from vastus lateralis (VL), tibialis anterior (TA), peroneus longus (PL), adductor hallucis (AH) abductor pollicis brevis (APB) bilaterally. effectiveness each muscle combination evaluated independently then compared other combinations using Akaike Information Criterion (AIC). Monitoring VL, TA, PL, AH yielded sensitivity 77.8% specificity 92.5% (AIC=66.7). PL 94.4% (AIC=62.4). TA 72.2% 93.5% (AIC=70.1). 96.3% (AIC=63.9). provided highest predictive power lower extremity weakness.