Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery

Eleraky, Mohammed A.; Setzer, Matthias; Papanastassiou, Ioannis D.; Baaj, Ali A.; Tran, Nam D.; Katsares, Kiesha M.; Vrionis, Frank D.

doi:10.1016/j.spinee.2010.02.015

« Previous Next »The Spine Journal
Volume 10, Issue 5 , Pages 396-403, May 2010

Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery

Mohammed A. Eleraky, MD
- H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program, University of South Florida College of Medicine, Tampa, FL 33612, USA
- Department of Neurosurgery, University of South Florida, College of Medicine, Tampa, FL 33612, USA
Matthias Setzer, MD
- H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program, University of South Florida College of Medicine, Tampa, FL 33612, USA
- Department of Neurosurgery, University of South Florida, College of Medicine, Tampa, FL 33612, USA
- Department of Neurosurgery, J. W. Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
Ioannis D. Papanastassiou, MD
- H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program, University of South Florida College of Medicine, Tampa, FL 33612, USA
- Department of Neurosurgery, University of South Florida, College of Medicine, Tampa, FL 33612, USA
Ali A. Baaj, MD
- H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program, University of South Florida College of Medicine, Tampa, FL 33612, USA
- Department of Neurosurgery, University of South Florida, College of Medicine, Tampa, FL 33612, USA
Nam D. Tran, MD
- H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program, University of South Florida College of Medicine, Tampa, FL 33612, USA
- Department of Neurosurgery, University of South Florida, College of Medicine, Tampa, FL 33612, USA
Kiesha M. Katsares, ARNP
- H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program, University of South Florida College of Medicine, Tampa, FL 33612, USA
- Department of Neurosurgery, University of South Florida, College of Medicine, Tampa, FL 33612, USA
Frank D. Vrionis, MD, PhD
- H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program, University of South Florida College of Medicine, Tampa, FL 33612, USA
- Department of Neurosurgery, University of South Florida, College of Medicine, Tampa, FL 33612, USA
- Corresponding author. H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA. Tel.: (813) 745-4251; fax: (813) 745-3713.

Received 8 October 2009; received in revised form 19 January 2010; accepted 14 February 2010.

Abstract

Background context

The vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia.

Purpose

The goal of this study was to evaluate a novel method of intraoperative testing of a nerve root's contribution to the blood supply of the thoracic spinal cord.

Study design/setting

This is a clinical retrospective study of 49 patients diagnosed with thoracic spine tumors. Temporary nerve root clipping combined with motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring was performed; additionally, postoperative clinical evaluation was done and reported in all cases.

Methods

All cases were monitored by SSEP and MEPs. The nerve root to be sacrificed was temporarily clipped using standard aneurysm clips, and SSEP/MEP were assessed before and after clipping. Four nerve roots were sacrificed in four cases, three nerve roots in eight cases, and two nerve roots in 22 cases. Nerve roots were sacrificed bilaterally in 12 cases.

Results

Most patients (47/49) had no changes in MEP/SSEP and had no neurological deficit postoperatively. One case of a spinal sarcoma demonstrated changes in MEP after temporary clipping of the left T11 nerve root. The nerve was not sacrificed, and the patient was neurologically intact after surgery. In another case of a sarcoma, MEPs changed in the lower limbs after ligation of left T9 nerve root. It was felt that it was a global event because of anesthesia. Postoperatively, the patient had complete paraplegia but recovered almost completely after 6 months.

Conclusions

Temporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome.

Keywords: Spine tumors, Nerve root, Motor-evoked potentials