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Transcranial Electric Motor Evoked Potential Monitoring During Spine Surgery: Is It Safe?

Schwartz, Daniel M. PhD, D.ABNM*; Sestokas, Anthony K. PhD, D.ABNM*; Dormans, John P. MD; Vaccaro, Alexander R. MD; Hilibrand, Alan S. MD; Flynn, John M. MD; Li, P. Mark MD, PhD§; Shah, Suken A. MD; Welch, William MD#; Drummond, Denis S. MD; Albert, Todd J. MD

doi: 10.1097/BRS.0b013e3181ecbe77

Study Design. Retrospective review.

Objective. To report on the safety of repetitive transcranial electric stimulation (RTES) for eliciting motor-evoked potentials during spine surgery.

Summary of Background Data. Theoretical concerns over the safety of RTES have hindered broader acceptance of transcranial electric motor-evoked potentials (tceMEP), despite successful implementation of spinal cord monitoring with tceMEPs in many large spine centers, as well as their apparent superiority over mixed-nerve somatosensory-evoked potentials (SSEP) for detection of spinal cord injury.

Methods. The records of 18,862 consecutive patients who met inclusion criteria and underwent spine surgery with tceMEP monitoring were reviewed for RTES-related complications.

Results. This large retrospective review identified only 26 (0.14%) cases with RTES-related complications; all but one of these were tongue lacerations, most of which were self-limiting.

Conclusions. The results demonstrate that RTES is a highly safe modality for monitoring spinal cord motor tract function intraoperatively.

Review of 18,862 consecutive spine procedures conducted with tceMEP monitoring of spinal cord and/or spinal nerve root function revealed few stimulation-related complications, largely limited to a low incidence of tongue lacerations. With proper technique, tceMEPs triggered by repetitive transcranial electric stimulation appear to be safe in both children and adults.

* Surgical Monitoring Associates, Springfi eld, PA

Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA

The Rothman Institute and Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA

§ Division of Neurosurgery, Lehigh Valley Hospital, Allentown, PA

Department of Orthopedics, Alfred I. duPont Hospital for Children, Wilmington, DE; and

# Department of Neurosurgery, The Pennsylvania Hospital, Philadelphia, PA.

Address correspondence and reprint requests to Daniel M. Schwartz, PhD, D.ABNM, Surgical Monitoring Associates, 900 Old Marple Road, Springfield, PA 19064. E-mail:

Acknowledgement date: March 29, 2010. Revision date: May 21, 2010. Accepted date: June 7, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Portions of this paper were presented at the 42nd Annual Meeting of the Scoliosis Research Society, Edinburgh, Scotland, September 6, 2007.

© 2011 Lippincott Williams & Wilkins, Inc.