The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy

Min Kyu Park,1 Sook Joung Lee,2 Sang Beom Kim,3 Kyeong Woo Lee,3 Hye-Jeong Lee,4 Eun Young Han,5 Bo Ryun Kim5 1Department of Pharmacology and Clinical Pharmacology, Dong-A University College of Medicine and Hospital, Busan, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Cat...

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Autores principales:	Park MK, Lee SJ, Kim SB, Lee KW, Lee HJ, Han EY, Kim BR
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	cervical myelopathy degenerative disorder intraoperative monitoring function positive change Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/05f2073d9b7d44d7b06d5a45ce00eaa4
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spelling	oai:doaj.org-article:05f2073d9b7d44d7b06d5a45ce00eaa42021-12-02T08:55:08ZThe effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy1178-1998https://doaj.org/article/05f2073d9b7d44d7b06d5a45ce00eaa42018-07-01T00:00:00Zhttps://www.dovepress.com/the-effect-of-positive-changes-during-intraoperative-monitoring-of-the-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Min Kyu Park,1 Sook Joung Lee,2 Sang Beom Kim,3 Kyeong Woo Lee,3 Hye-Jeong Lee,4 Eun Young Han,5 Bo Ryun Kim5 1Department of Pharmacology and Clinical Pharmacology, Dong-A University College of Medicine and Hospital, Busan, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Catholic University of Korea, Daejeon St Mary’s Hospital, Daejeon, Republic of Korea; 3Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Dong-A University Hospital, Busan, Republic of Korea; 4Department of Pharmacology, College of Medicine, Dong-A University, Busan, Republic of Korea; 5Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea Background: Cervical compressive myelopathy (CCM) is a progressive, degenerative spine disease and the most common cause of spinal cord dysfunction in older individuals. Current clinical guidelines for spinal surgery recommend multimodal intraoperative monitoring (IOM) during spinal surgery as a reliable and valid diagnostic adjunct to assess spinal cord integrity. The aim of this study was to evaluate the effect of positive changes during IOM on the functional status in patients with CCM.Methods: Patients who underwent spinal surgery with IOM due to CCM were enrolled. During the surgery, patients underwent IOM using motor evoked potential (MEP) and somatosensory evoked potential (SEP). MEP and SEP were checked before and immediately after decompression. A decrease in latency >10% or an increase in amplitude >50% was regarded as a “positive changes”. Subjects were divided according to the presence of positive changes. Motor scores of American Spinal Injury Association (ASIA) impairment scale and Korean version of Modified Barthel Index (K-MBI) were evaluated before and after operation.Results: Twenty-nine patients underwent spinal surgery due to CCM. Eleven patients showed positive changes in MEP during IOM. When the two groups were compared, improvement rate in the ASIA motor score and K-MBI were significantly higher in patients with positive changes than in patients without positive changes at 1 month after surgery. However, 6 months after surgery, there were no significance differences between the groups. Regardless of positive change, nearly all patients suffered from neuropathic pain after operation.Conclusion: Positive changes in MEP during IOM may affect functional improvement 1 month after operation and early discharge without significant complications in CCM patients. However, they do not affect the neuropathic pain and long-term functional outcome. Thus, tailored proper management is needed to achieve maximal functional recovery in each patient after cervical spinal decompression surgery. Keywords: cervical myelopathy, degenerative disorder, intraoperative monitoring, function, positive changePark MKLee SJKim SBLee KWLee HJHan EYKim BRDove Medical Pressarticlecervical myelopathydegenerative disorderintraoperative monitoringfunctionpositive changeGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 13, Pp 1211-1218 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	cervical myelopathy degenerative disorder intraoperative monitoring function positive change Geriatrics RC952-954.6
spellingShingle	cervical myelopathy degenerative disorder intraoperative monitoring function positive change Geriatrics RC952-954.6 Park MK Lee SJ Kim SB Lee KW Lee HJ Han EY Kim BR The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy
description	Min Kyu Park,1 Sook Joung Lee,2 Sang Beom Kim,3 Kyeong Woo Lee,3 Hye-Jeong Lee,4 Eun Young Han,5 Bo Ryun Kim5 1Department of Pharmacology and Clinical Pharmacology, Dong-A University College of Medicine and Hospital, Busan, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Catholic University of Korea, Daejeon St Mary’s Hospital, Daejeon, Republic of Korea; 3Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Dong-A University Hospital, Busan, Republic of Korea; 4Department of Pharmacology, College of Medicine, Dong-A University, Busan, Republic of Korea; 5Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea Background: Cervical compressive myelopathy (CCM) is a progressive, degenerative spine disease and the most common cause of spinal cord dysfunction in older individuals. Current clinical guidelines for spinal surgery recommend multimodal intraoperative monitoring (IOM) during spinal surgery as a reliable and valid diagnostic adjunct to assess spinal cord integrity. The aim of this study was to evaluate the effect of positive changes during IOM on the functional status in patients with CCM.Methods: Patients who underwent spinal surgery with IOM due to CCM were enrolled. During the surgery, patients underwent IOM using motor evoked potential (MEP) and somatosensory evoked potential (SEP). MEP and SEP were checked before and immediately after decompression. A decrease in latency >10% or an increase in amplitude >50% was regarded as a “positive changes”. Subjects were divided according to the presence of positive changes. Motor scores of American Spinal Injury Association (ASIA) impairment scale and Korean version of Modified Barthel Index (K-MBI) were evaluated before and after operation.Results: Twenty-nine patients underwent spinal surgery due to CCM. Eleven patients showed positive changes in MEP during IOM. When the two groups were compared, improvement rate in the ASIA motor score and K-MBI were significantly higher in patients with positive changes than in patients without positive changes at 1 month after surgery. However, 6 months after surgery, there were no significance differences between the groups. Regardless of positive change, nearly all patients suffered from neuropathic pain after operation.Conclusion: Positive changes in MEP during IOM may affect functional improvement 1 month after operation and early discharge without significant complications in CCM patients. However, they do not affect the neuropathic pain and long-term functional outcome. Thus, tailored proper management is needed to achieve maximal functional recovery in each patient after cervical spinal decompression surgery. Keywords: cervical myelopathy, degenerative disorder, intraoperative monitoring, function, positive change
format	article
author	Park MK Lee SJ Kim SB Lee KW Lee HJ Han EY Kim BR
author_facet	Park MK Lee SJ Kim SB Lee KW Lee HJ Han EY Kim BR
author_sort	Park MK
title	The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy
title_short	The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy
title_full	The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy
title_fullStr	The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy
title_full_unstemmed	The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy
title_sort	effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/05f2073d9b7d44d7b06d5a45ce00eaa4
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The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy

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