Cause analyses and strategies on abnormalities of multimodal intraoperative eletroneurophilogy monitoring in spinal surgery cases

English Keywords:Spinal surgery  Multimodal intraoperative neurology monitoring  Somatosensory evoked potential  Transcranial electrical stimulation motor evoked potentials  Free-run electromyography

English Abstract:

  【Abstract】 Objectives: To analyze the causes of the abnormalities in intraoperative eletroneurophilogy monitoring in spinal surgery, and to investigate the strategies for improving the monitoring success rate. Methods: A total of 476 cases of spinal surgery with multimodal intraoperative eletroneurophilogy monitoring, including somatosensory evoked potential(SEP), transcranial electrical stimulation motor evoked potentials(MEP) and free-run electromyography(Free-run EMG), was analyzed retrospectively. Results: Abnormal waveforms were detected in 76 cases. Twenty-one of them had preoperative neurological disorders. Abnormalities in 8 cases were caused by iatrogenic nerve impairment. The other abnormalities were caused by inappropriate use of muscle relaxant(7 cases), inappropriate use of inhaled anesthetics(8 cases), lower limb muscle tremors(3 cases), electromagnetic field interference(4 cases), improper operative position(7 cases), incorrect link of electrode wires(7 cases) and unknown reasons(11 cases) respectively. Among the abnormal cases, twenty-eight returned to normal after effective intervention. Conclusions: Several aspects, including operation technique, anesthesia, electromagnetic environment and patient factors, should be taken into consideration for coping with monitor abnormalities. Positive and effective measures should be taken for better monitoring.