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The muscle evoked potential after epidural electrical stimulation of the spinal cord as a monitor for the corticospinal tract: studies by collision technique and double train stimulation

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Abstract

To study if spinal motor evoked potentials (SpMEPs), muscle responses after electrical stimulation of the spinal cord, can monitor the corticospinal tract. Study 1 comprised 10 consecutive cervical or thoracic myelopathic patients. We recorded three types of muscle responses intraoperatively: (1) transcranial motor evoked potentials (TcMEPs), (2) SpMEPs and (3) SpMEPs + TcMEPs from the abductor hallucis (AH) using train stimulation. Study 2 dealt with 5 patients, who underwent paired train stimulation to the spinal cord with intertrain interval of 50–60 ms for recording AH SpMEPs. We will also describe two illustrative cases to demonstrate the clinical value of AH SpMEPs for monitoring the motor pathway. In Study 1, SpMEPs and SpMEPs + TcMEPs recorded from AH measured nearly the same, suggesting the collision of the cranially evoked volleys with the antidromic signals induced by spinal cord stimulation via the corticospinal tracts. In Study 2, the first and second train stimuli elicited almost identical SpMEPs, indicating a quick return of transmission after 50–60 ms considered characteristic of the corticospinal tract rather than the dorsal column, which would have recovered much more slowly. Of the two patients presented, one had no post-operative neurological deteriorations as anticipated by stable SpMEPs, despite otherwise insufficient IONM, and the other developed post-operative motor deficits as predicted by simultaneous reduction of TcMEPs and SpMEPs in the face of normal SEPs. Electrical stimulation of the spinal cord primarily activates the corticospinal tract to mediate SpMEPs.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kansai Medical University, 2-3-1Shin machi, Hirakata City, Osaka, 573-1191, Japan

    Muneharu Ando & Takanori Saito

  2. Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama City, Wakayama, 640-8505, Japan

    Muneharu Ando, Kazuhiro Maio & Hiroki Iwahashi

  3. Aitoku Medical and Welfare Center, 3-5-41 Imafuku, Wakayama City, Wakayama, 641-0044, Japan

    Tetsuya Tamaki

  4. Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan

    Hiroshi Iwasaki & Hiroshi Yamada

  5. Department of Orthopedic Surgery, Kubokawa Hospital, 902-1 Mitsuke Shimanto cho, Takaoka gun, Kochi, 786-0002, Japan

    Toshikazu Tani

  6. Division of Clinical Electrophysiology, Department of Neurology, University of Iowa Health Care, Iowa City, IA, 52242, USA

    Jun Kimura

Authors
  1. Muneharu Ando
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  2. Tetsuya Tamaki
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  4. Hiroki Iwahashi
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  5. Hiroshi Iwasaki
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  7. Toshikazu Tani
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  8. Takanori Saito
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  9. Jun Kimura
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Contributions

MA and TT designed the study. MA, KM and HI performed surgeries and collected data. HY and HIwasa analyzed the data statistically. MA wrote the article with editing from co-authors. TT, TT, TS and JK supervised the study. All authors approved the final article.

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Correspondence to Muneharu Ando.

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Conflict of interest

None of the authors have potential conflicts of interest to be disclosed.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (Wakayama Rosai Hospital ethics committee, number 15–26) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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This study was performed at Wakayama Rosai Hospital.

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Ando, M., Tamaki, T., Maio, K. et al. The muscle evoked potential after epidural electrical stimulation of the spinal cord as a monitor for the corticospinal tract: studies by collision technique and double train stimulation. J Clin Monit Comput 36, 1053–1067 (2022). https://doi.org/10.1007/s10877-021-00735-8

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  • DOI: https://doi.org/10.1007/s10877-021-00735-8

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