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Daniel Haschtmann - One of the best experts on this subject based on the ideXlab platform.
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the impact and value of uni and multimodal intraoperative Neurophysiological Monitoring ionm on neurological complications during spine surgery a prospective study of 2728 patients
2019Co-Authors: Martin Sutter, Dezso Jeszenszky, Tamas F Fekete, Daniel Haschtmann, Andreas Eggspuehler, Frank S Kleinstueck, Francois Porchet, Jiri DvorakAbstract:We compared the value of different uni- and multimodal intraoperative Neurophysiological Monitoring (IONM) methods on the detection of neurological complications during spine surgery. IONM data derived from sensory spinal and cortical evoked potentials combined with continuous electromyography Monitoring, motor evoked potentials and spinal recording were evaluated in relation to subsequent post-operative neurological changes. Patients were categorised based on their true-positive or true-negative post-operative neurological status. In 2728 consecutive patients we had 909 (33.3%) IONM alerts. We had 8 false negatives (0.3%) with post-operative radicular deficit that completely recovered within 3 months, except for one. There was no false negative for spinal cord injury. 107 were true positives, and 23 were false positives. Multimodal IONM sensitivity and specificity were 93.0% and 99.1%, respectively. The frequency of neurological complications including minor deficits was 4.2% (n = 115), of which 0.37% (n = 10) were permanent. Analysis of the single IONM modalities varied between 13 and 81% to detect neurological complications compared with 93% when using all modalities. Multimodal IONM is more effective and accurate in assessing spinal cord and nerve root function during spine surgeries to reduce both neurological complications and false-negative findings compared to unimodal Monitoring. We recommend multimodal IONM in all complex spine surgeries. These slides can be retrieved from Electronic Supplementary Material.
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outcome of l5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high grade l5 s1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring
2017Co-Authors: Ralph T Schar, Martin Sutter, Anne F Mannion, Andreas Eggspuhler, Dezso Jeszenszky, Tamas F Fekete, Frank Kleinstuck, Daniel HaschtmannAbstract:Purpose To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5–S1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring (IONM).
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outcome of l5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high grade l5 s1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring
2017Co-Authors: Ralph T Schar, Martin Sutter, Anne F Mannion, Andreas Eggspuhler, Dezso Jeszenszky, Tamas F Fekete, Frank Kleinstuck, Daniel HaschtmannAbstract:To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5–S1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring (IONM). Consecutive patients treated for high-grade spondylolisthesis with IONM from 2005 to 2013 were screened for eligibility. Prospectively collected clinical and surgical data as well as radiographic outcomes were analyzed retrospectively. Patients completed the multidimensional Core Outcome Measures Index (COMI) before and at 3, 12, and 24 months after surgery. Seventeen patients were included, with a mean age of 26.3 (±9.5) years. Mean preoperative L5–S1 slip was 72% (±21%) and was reduced to 19% (±13%) postoperatively. Mean loss of reduction at last follow-up [mean 19 months (±14, range 3–48 months)] was 3% (±4.3%). Rate of new L5 radiculopathy with motor deficit (L5MD) after surgery was 29% (five patients). Four patients fully recovered after 3 months, one patient was lost to neurologic follow-up. IONM sensitivity and specificity for postoperative L5MD was 20 and 100%, respectively. COMI, back pain and leg pain scores showed significant (p < 0.001) improvements at 3 months postoperatively, which were retained up to 24 months postoperatively. Transient L5 radiculopathy after reduction and instrumented fusion of high-grade spondylolisthesis is frequent. With IONM the risk of irreversible L5 radiculopathy is minimal. If IONM signal changes recover, full clinical recovery is expected within 3 months. Overall, patient-reported outcome of reduction and instrumented fusion of high-grade spondylolisthesis showed clinically important improvement.
Andrea Szelenyi - One of the best experts on this subject based on the ideXlab platform.
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intraspinal epidermoid and dermoid cysts tumor resection with multimodal intraoperative Neurophysiological Monitoring and long term outcome
2020Co-Authors: Sebastian Siller, Stefan Zausinger, Joerg-christian Tonn, Andrea Szelenyi, Rupert Egensperger, Christian SchichorAbstract:Background Intraspinal epidermoid/dermoid cysts are very rare, benign tumors arising from pathological displacement of epidermal cells into the spinal canal. Literature data about the long-term outcome after microsurgical resection with multimodal intraoperative Neurophysiological Monitoring (IONM) are lacking. We analyzed one of the largest case series with special regard to intraoperative characteristics and long-term outcome after IONM-aided surgery. Method All 12 patients (m:f = 1.4:1) who underwent microsurgical tumor resection with multimodal IONM for intraspinal epidermoid/dermoid tumors between 1998 and 2019 in our university hospital were included. We retrospectively investigated the patients' characteristics, imaging/surgical parameters, and postoperative long-term outcomes. Results Symptomatic tumor manifestation was seen during adulthood in 4 patients (median age 33.0 years) and during childhood in 8 patients (median age 4.3 years). Spinal dysraphism was the most often comorbidity (75%). The most frequent symptoms at diagnosis were spastic pareses (75%), ataxia (58%), and vegetative disorders (42%). Tumors were most often lumbosacral (L1-L5 42%, L5-S3 50%) and intradural-extramedullary (92%). For microsurgical resection, IONM with EMG, SSEPs, and TcMEPs of the limbs and pudendal nerve/anal sphincter was always applied and feasible; intraoperative corrective actions were initiated in three cases due to transient IONM deterioration. None of the patients showed a postoperative deterioration of the neurological status with a gross total resection rate of 92%. Pain situation, McCormick grade, and mJOA Score were improved at long-term follow-up (median 4.8 years). Conclusions IONM-aided resection of intraspinal epidermoid/dermoid tumors is feasible both in adult and pediatric cases and enables a satisfying clinical and surgical outcome.
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Indication and technical implementation of the intraoperative Neurophysiological Monitoring during spine surgeries-a transnational survey in the German-speaking countries.
2019Co-Authors: Sebastian Siller, Constance Raith, Stefan Zausinger, Joerg-christian Tonn, Andrea SzelenyiAbstract:Background Intraoperative Neurophysiological Monitoring is widely used in spine surgery (sIONM). But guidelines are lacking and its use is mainly driven by individual surgeons’ preferences and medicolegal advisements. To gain an overview over the current status of sIONM implementation, we conducted a transnational survey in the German-speaking countries.
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indication and technical implementation of the intraoperative Neurophysiological Monitoring during spine surgeries a transnational survey in the german speaking countries
2019Co-Authors: Sebastian Siller, Constance Raith, Stefan Zausinger, Joerg-christian Tonn, Andrea SzelenyiAbstract:Intraoperative Neurophysiological Monitoring is widely used in spine surgery (sIONM). But guidelines are lacking and its use is mainly driven by individual surgeons’ preferences and medicolegal advisements. To gain an overview over the current status of sIONM implementation, we conducted a transnational survey in the German-speaking countries. We developed a Web interface-based survey assessing prevalence, indication, technical implementation, and general satisfaction regarding sIONM in German, Austrian, and Swiss spine centers. The electronic survey was performed between November 2017 and April 2018, including both neurosurgical and orthopedic spine centers. A total of 463 German, 60 Austrian, and 52 Swiss spine centers were contacted with participation rates of 64.1% (Germany), 68.3% (Austria), and 55.8% (Switzerland). Some 75.9% participating neurosurgical spine centers and only 14.7% of the orthopedic spine centers applied sIONM. Motor- and somatosensory-evoked potentials (93.7% and 94.3%, respectively) were the most widely available modalities, followed by direct wave (D wave; 66.5%). Whereas sIONM utilization was low in spine surgeries for degenerative, traumatic, and extradural tumor diseases, it was high for scoliosis and intradural tumor surgeries. Overall, the general satisfaction within the institutional setting regarding technical skills, staff, performance, and reliability of sIONM was rated as “high” by more than three-quarters of the centers. However, shortage of skilled staff was claimed to be a negative factor by 41.1% of the centers and reimbursement was considered to be insufficient by 83.5%. sIONM availability was high in neurosurgical but low in orthopedic spine centers. Main modalities were motor/somatosensory-evoked potentials and main indications were scoliosis and intradural spinal tumor surgeries. A more frequent sIONM use, however, was mainly limited by the shortage of skilled staff and restricted reimbursement.
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spinal cord hemangioblastomas significance of intraoperative Neurophysiological Monitoring for resection and long term outcome
2017Co-Authors: Sebastian Siller, Joerg-christian Tonn, Andrea Szelenyi, Lisa Herlitz, Stefan ZausingerAbstract:OBJECTIVE Spinal cord hemangioblastomas are rare benign tumors developing either sporadically or as part of von Hippel-Lindau (VHL) disease. Generally, resection is the treatment of choice. However, the significance of intraoperative Neurophysiological Monitoring (IONM) for resection and postoperative outcome is still controversial. The authors analyzed the surgical and clinical courses of patients who had undergone resection of spinal cord hemangioblastoma, with special attention to preoperative imaging, the use of IONM, and short- and long-term outcomes. METHODS A series of 24 patients (male/female 1:1, lesion sporadic/associated with VHL 2.4:1) who had undergone 26 operations for the resection of 27 spinal cord hemangioblastomas was analyzed. All patients had undergone pre- and postoperative contrast-enhanced MRI. In all cases, microsurgical tumor removal had been performed under continuous IONM of both somatosensory and transcranial motor evoked potentials as well as electromyographic recording. Clinical characteristics, imaging findings, and operative records were retrospectively analyzed. Outcome parameters included short- and long-term status as regards sensorimotor deficits and a questionnaire on general performance, patient satisfaction, and Oswestry Disability Index (ODI) at the end of the follow-up period. The impact of IONM findings on postoperative deficits and outcome parameters as well as risk factors affecting functional prognosis was statistically assessed. RESULTS Preoperative symptoms (mean duration 16.2 ± 22.0 months) included sensory changes (100.0%), pain (66.7%), spinal ataxia (66.7%), motor deficit (41.7%), and bladder/bowel dysfunction (12.5%). Average age at the first operation was 36.8 ± 12.8 years. Most tumors (21 intramedullary, 6 intra- and/or extramedullary) were located dorsally (92.6%) and cervically (77.8%) and were accompanied by peritumoral edema and/or syringomyelia (81.5%). Tumor resection was achieved via laminectomy for 15 tumors, hemilaminectomy for 5, laminoplasty for 6, and interlaminar approach for 1. Gross-total resection was accomplished for 26 tumors (96.3%) with no local tumor recurrence during follow-up. Intraoperative Neurophysiological Monitoring was nonpathological in 11 operations (42.3%) and pathological in 15 (57.7%). Patients with nonpathological IONM had significantly fewer new sensorimotor deficits (p = 0.005). Long-term follow-up evaluation (mean 7.9 ± 4.0 years postoperatively, 7 patients lost to follow-up) revealed a stable or improved McCormick myelopathy grade in 88.2% of the patients, and 88.2% reported a stable or improved overall outcome according to Odom's criteria. Long-term general performance was excellent with 88.2% having a WHO/Eastern Cooperative Oncology Group (ECOG) Performance Status grade ≤ 1, 76.5% a Karnofsky Performance Scale score ≥ 80, and 70.6% a Barthel Index (BI) of 100. The mean ODI (11.4% ± 12.5%) indicated only minimal disability. There was a significant correlation between pathological IONM findings and a worse long-term status according to the BI and ODI (p = 0.011 and 0.024, respectively). Additionally, VHL disease was a risk factor affecting functional prognosis (p = 0.044). CONCLUSIONS Microsurgical removal of spinal cord hemangioblastomas with IONM facilitates a satisfying long-term outcome for patients. Nonpathological IONM findings are associated with a lower risk of new sensorimotor deficits and correlate with a better overall long-term outcome. von Hippel-Lindau disease is a risk factor for a worse long-term prognosis.
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Spinal cord tumor surgery--importance of continuous intraoperative Neurophysiological Monitoring after tumor resection.
2012Co-Authors: Marie-therese Forster, Gerhard Marquardt, Volker Seifert, Andrea SzelenyiAbstract:STUDY DESIGN A retrospective clinical analysis of patients operated on for spinal tumors. OBJECTIVE To report on the importance of intraoperative Neurophysiological Monitoring (INM) throughout the entire surgical procedure. SUMMARY OF BACKGROUND DATA Postoperative neurological deterioration, despite unaltered Neurophysiological Monitoring, has been reported. This might be related to timely restricted Monitoring. Thus, the likelihood of alterations in INM from positioning to wound closure was analyzed. METHODS Two hundred three patients (age range, 54.9 ± 17.4 yr) undergoing intradural tumor removal were sampled in a prospective database and analyzed for the occurrence of alterations in intraoperative somatosensory- and motor-evoked potentials. RESULTS INM alterations were observed in 47 of 203 (23.2%) patients. These alterations were related to tumor resection in 29 (14.3%) cases, whereas these were unrelated to tumor removal in 18 patients: laminotomy in 5 (2.5%) patients, dura opening in 7 (3.5%) patients, dura closure in 5 (2.5%) patients, and laminoplasty in 1 (0.5%) patient caused INM changes. CONCLUSION This study demonstrates that Monitoring beyond tumor resection is of essential importance in order to detect all critical phases of surgical procedure and to counteract accordingly.
Martin Sutter - One of the best experts on this subject based on the ideXlab platform.
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the impact and value of uni and multimodal intraoperative Neurophysiological Monitoring ionm on neurological complications during spine surgery a prospective study of 2728 patients
2019Co-Authors: Martin Sutter, Dezso Jeszenszky, Tamas F Fekete, Daniel Haschtmann, Andreas Eggspuehler, Frank S Kleinstueck, Francois Porchet, Jiri DvorakAbstract:We compared the value of different uni- and multimodal intraoperative Neurophysiological Monitoring (IONM) methods on the detection of neurological complications during spine surgery. IONM data derived from sensory spinal and cortical evoked potentials combined with continuous electromyography Monitoring, motor evoked potentials and spinal recording were evaluated in relation to subsequent post-operative neurological changes. Patients were categorised based on their true-positive or true-negative post-operative neurological status. In 2728 consecutive patients we had 909 (33.3%) IONM alerts. We had 8 false negatives (0.3%) with post-operative radicular deficit that completely recovered within 3 months, except for one. There was no false negative for spinal cord injury. 107 were true positives, and 23 were false positives. Multimodal IONM sensitivity and specificity were 93.0% and 99.1%, respectively. The frequency of neurological complications including minor deficits was 4.2% (n = 115), of which 0.37% (n = 10) were permanent. Analysis of the single IONM modalities varied between 13 and 81% to detect neurological complications compared with 93% when using all modalities. Multimodal IONM is more effective and accurate in assessing spinal cord and nerve root function during spine surgeries to reduce both neurological complications and false-negative findings compared to unimodal Monitoring. We recommend multimodal IONM in all complex spine surgeries. These slides can be retrieved from Electronic Supplementary Material.
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outcome of l5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high grade l5 s1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring
2017Co-Authors: Ralph T Schar, Martin Sutter, Anne F Mannion, Andreas Eggspuhler, Dezso Jeszenszky, Tamas F Fekete, Frank Kleinstuck, Daniel HaschtmannAbstract:Purpose To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5–S1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring (IONM).
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outcome of l5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high grade l5 s1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring
2017Co-Authors: Ralph T Schar, Martin Sutter, Anne F Mannion, Andreas Eggspuhler, Dezso Jeszenszky, Tamas F Fekete, Frank Kleinstuck, Daniel HaschtmannAbstract:To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5–S1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring (IONM). Consecutive patients treated for high-grade spondylolisthesis with IONM from 2005 to 2013 were screened for eligibility. Prospectively collected clinical and surgical data as well as radiographic outcomes were analyzed retrospectively. Patients completed the multidimensional Core Outcome Measures Index (COMI) before and at 3, 12, and 24 months after surgery. Seventeen patients were included, with a mean age of 26.3 (±9.5) years. Mean preoperative L5–S1 slip was 72% (±21%) and was reduced to 19% (±13%) postoperatively. Mean loss of reduction at last follow-up [mean 19 months (±14, range 3–48 months)] was 3% (±4.3%). Rate of new L5 radiculopathy with motor deficit (L5MD) after surgery was 29% (five patients). Four patients fully recovered after 3 months, one patient was lost to neurologic follow-up. IONM sensitivity and specificity for postoperative L5MD was 20 and 100%, respectively. COMI, back pain and leg pain scores showed significant (p < 0.001) improvements at 3 months postoperatively, which were retained up to 24 months postoperatively. Transient L5 radiculopathy after reduction and instrumented fusion of high-grade spondylolisthesis is frequent. With IONM the risk of irreversible L5 radiculopathy is minimal. If IONM signal changes recover, full clinical recovery is expected within 3 months. Overall, patient-reported outcome of reduction and instrumented fusion of high-grade spondylolisthesis showed clinically important improvement.
Tamas F Fekete - One of the best experts on this subject based on the ideXlab platform.
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the impact and value of uni and multimodal intraoperative Neurophysiological Monitoring ionm on neurological complications during spine surgery a prospective study of 2728 patients
2019Co-Authors: Martin Sutter, Dezso Jeszenszky, Tamas F Fekete, Daniel Haschtmann, Andreas Eggspuehler, Frank S Kleinstueck, Francois Porchet, Jiri DvorakAbstract:We compared the value of different uni- and multimodal intraoperative Neurophysiological Monitoring (IONM) methods on the detection of neurological complications during spine surgery. IONM data derived from sensory spinal and cortical evoked potentials combined with continuous electromyography Monitoring, motor evoked potentials and spinal recording were evaluated in relation to subsequent post-operative neurological changes. Patients were categorised based on their true-positive or true-negative post-operative neurological status. In 2728 consecutive patients we had 909 (33.3%) IONM alerts. We had 8 false negatives (0.3%) with post-operative radicular deficit that completely recovered within 3 months, except for one. There was no false negative for spinal cord injury. 107 were true positives, and 23 were false positives. Multimodal IONM sensitivity and specificity were 93.0% and 99.1%, respectively. The frequency of neurological complications including minor deficits was 4.2% (n = 115), of which 0.37% (n = 10) were permanent. Analysis of the single IONM modalities varied between 13 and 81% to detect neurological complications compared with 93% when using all modalities. Multimodal IONM is more effective and accurate in assessing spinal cord and nerve root function during spine surgeries to reduce both neurological complications and false-negative findings compared to unimodal Monitoring. We recommend multimodal IONM in all complex spine surgeries. These slides can be retrieved from Electronic Supplementary Material.
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outcome of l5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high grade l5 s1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring
2017Co-Authors: Ralph T Schar, Martin Sutter, Anne F Mannion, Andreas Eggspuhler, Dezso Jeszenszky, Tamas F Fekete, Frank Kleinstuck, Daniel HaschtmannAbstract:Purpose To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5–S1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring (IONM).
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outcome of l5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high grade l5 s1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring
2017Co-Authors: Ralph T Schar, Martin Sutter, Anne F Mannion, Andreas Eggspuhler, Dezso Jeszenszky, Tamas F Fekete, Frank Kleinstuck, Daniel HaschtmannAbstract:To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5–S1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring (IONM). Consecutive patients treated for high-grade spondylolisthesis with IONM from 2005 to 2013 were screened for eligibility. Prospectively collected clinical and surgical data as well as radiographic outcomes were analyzed retrospectively. Patients completed the multidimensional Core Outcome Measures Index (COMI) before and at 3, 12, and 24 months after surgery. Seventeen patients were included, with a mean age of 26.3 (±9.5) years. Mean preoperative L5–S1 slip was 72% (±21%) and was reduced to 19% (±13%) postoperatively. Mean loss of reduction at last follow-up [mean 19 months (±14, range 3–48 months)] was 3% (±4.3%). Rate of new L5 radiculopathy with motor deficit (L5MD) after surgery was 29% (five patients). Four patients fully recovered after 3 months, one patient was lost to neurologic follow-up. IONM sensitivity and specificity for postoperative L5MD was 20 and 100%, respectively. COMI, back pain and leg pain scores showed significant (p < 0.001) improvements at 3 months postoperatively, which were retained up to 24 months postoperatively. Transient L5 radiculopathy after reduction and instrumented fusion of high-grade spondylolisthesis is frequent. With IONM the risk of irreversible L5 radiculopathy is minimal. If IONM signal changes recover, full clinical recovery is expected within 3 months. Overall, patient-reported outcome of reduction and instrumented fusion of high-grade spondylolisthesis showed clinically important improvement.
Dezso Jeszenszky - One of the best experts on this subject based on the ideXlab platform.
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the impact and value of uni and multimodal intraoperative Neurophysiological Monitoring ionm on neurological complications during spine surgery a prospective study of 2728 patients
2019Co-Authors: Martin Sutter, Dezso Jeszenszky, Tamas F Fekete, Daniel Haschtmann, Andreas Eggspuehler, Frank S Kleinstueck, Francois Porchet, Jiri DvorakAbstract:We compared the value of different uni- and multimodal intraoperative Neurophysiological Monitoring (IONM) methods on the detection of neurological complications during spine surgery. IONM data derived from sensory spinal and cortical evoked potentials combined with continuous electromyography Monitoring, motor evoked potentials and spinal recording were evaluated in relation to subsequent post-operative neurological changes. Patients were categorised based on their true-positive or true-negative post-operative neurological status. In 2728 consecutive patients we had 909 (33.3%) IONM alerts. We had 8 false negatives (0.3%) with post-operative radicular deficit that completely recovered within 3 months, except for one. There was no false negative for spinal cord injury. 107 were true positives, and 23 were false positives. Multimodal IONM sensitivity and specificity were 93.0% and 99.1%, respectively. The frequency of neurological complications including minor deficits was 4.2% (n = 115), of which 0.37% (n = 10) were permanent. Analysis of the single IONM modalities varied between 13 and 81% to detect neurological complications compared with 93% when using all modalities. Multimodal IONM is more effective and accurate in assessing spinal cord and nerve root function during spine surgeries to reduce both neurological complications and false-negative findings compared to unimodal Monitoring. We recommend multimodal IONM in all complex spine surgeries. These slides can be retrieved from Electronic Supplementary Material.
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outcome of l5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high grade l5 s1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring
2017Co-Authors: Ralph T Schar, Martin Sutter, Anne F Mannion, Andreas Eggspuhler, Dezso Jeszenszky, Tamas F Fekete, Frank Kleinstuck, Daniel HaschtmannAbstract:Purpose To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5–S1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring (IONM).
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outcome of l5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high grade l5 s1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring
2017Co-Authors: Ralph T Schar, Martin Sutter, Anne F Mannion, Andreas Eggspuhler, Dezso Jeszenszky, Tamas F Fekete, Frank Kleinstuck, Daniel HaschtmannAbstract:To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5–S1 isthmic spondylolisthesis and the role of intraoperative Neurophysiological Monitoring (IONM). Consecutive patients treated for high-grade spondylolisthesis with IONM from 2005 to 2013 were screened for eligibility. Prospectively collected clinical and surgical data as well as radiographic outcomes were analyzed retrospectively. Patients completed the multidimensional Core Outcome Measures Index (COMI) before and at 3, 12, and 24 months after surgery. Seventeen patients were included, with a mean age of 26.3 (±9.5) years. Mean preoperative L5–S1 slip was 72% (±21%) and was reduced to 19% (±13%) postoperatively. Mean loss of reduction at last follow-up [mean 19 months (±14, range 3–48 months)] was 3% (±4.3%). Rate of new L5 radiculopathy with motor deficit (L5MD) after surgery was 29% (five patients). Four patients fully recovered after 3 months, one patient was lost to neurologic follow-up. IONM sensitivity and specificity for postoperative L5MD was 20 and 100%, respectively. COMI, back pain and leg pain scores showed significant (p < 0.001) improvements at 3 months postoperatively, which were retained up to 24 months postoperatively. Transient L5 radiculopathy after reduction and instrumented fusion of high-grade spondylolisthesis is frequent. With IONM the risk of irreversible L5 radiculopathy is minimal. If IONM signal changes recover, full clinical recovery is expected within 3 months. Overall, patient-reported outcome of reduction and instrumented fusion of high-grade spondylolisthesis showed clinically important improvement.