Surgical Spinal Cord Monitoring May Predict Paralysis

Use of electrical motor evoked potentials called for during spinal and some chest surgeries

MONDAY, Feb. 20 (HealthDay News) -- Intraoperative monitoring (IOM) of the spinal cord with somatosensory and transcranial electrical motor evoked potentials (EPs) during spinal surgery and certain chest surgeries can help predict surgery-related paralysis and possibly allow for intervention, according to new guidelines published by the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (AAN) in the Feb. 21 issue of Neurology.

Marc R. Nuwer, M.D., Ph.D., from the University of California Los Angeles, and panel colleagues reviewed the literature and classified studies (Four Class I and eight Class II) according to the evidence-based methodology of the AAN. Objective outcomes of postoperative onset of paraparesis, paraplegia, and quadriplegia were assessed because no randomized or masked studies were available.

The researchers found that all four Class I studies and seven of the eight Class II studies reached significance in showing that paraparesis, paraplegia, and quadriplegia occurred in the IOM patients with EP changes, compared with the IOM patients without EP changes. All studies consistently showed that paraparesis, paraplegia, and quadriplegia occurred only in the IOM patients with EP changes, and did not occur in patients without EP changes. In the Class I studies, 16 to 40 percent of the IOM patients with EP changes developed postoperative-onset paraparesis, paraplegia, or quadriplegia.

"IOM is established as effective to predict an increased risk of the adverse outcomes of paraparesis, paraplegia, and quadriplegia in spinal surgery (four Class I and seven Class II studies)," the authors write.

Several authors disclosed financial ties to pharmaceutical and medical device companies.

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