Abstract
BACKGROUND CONTEXT Peripheral nerve injuries of the upper extremities in patients undergoing posterior thoracolumbar surgery is a well described, yet preventable complication. Upper extremity (UE) neuromonitoring has been utilized to alert the surgeon of the development of such an injury. PURPOSE The purpose of this study is to investigate the occurrence of upper extremity neuromonitoring changes in patients undergoing thoracolumbar surgery in prone position and to assess the significance of these changes in terms of procedure and patient characteristics, and in preventing postoperative UE neuropathy. STUDY DESIGN/SETTING Pair-matched case-control study (Level III) design, university hospital setting. PATIENT SAMPLE A total of 843 consecutive patients from single institution. OUTCOME MEASURES Presence or absence of postoperative upper extremity neuropathy. METHODS All patients who underwent posterior thoracic, lumbar, or thoracolumbar surgery at a single institution from 2014 to 2016 with neuromonitoring were included in the study. UE neuromonitoring consisted of ulnar somatosensory evoked potentials (SSEPs). Patients with intraoperative ulnar SSEP signal changes were identified and compared with a group of pair-matched patients who did not develop intraoperative ulnar SSEP signal changes. The groups were matched based on the number of vertebral levels undergoing surgery. Data regarding intraoperative attempts to resolve signal changes and outcomes were collected. The two groups were compared to identify the risk factors for the development of UE neuromonitoring changes. RESULTS Between January 2014 and December 2016, 843 patients in our institution underwent thoracic, lumbar or thoracolumbar spine surgeries in prone position with intraoperative bilateral ulnar SSEPs neuromonitoring data available. Of these, 37 patients (4.4%) had intraoperative signal changes in the UE; an equal number of patients without signal changes were also selected. In each group, six patients underwent thoracic, 20 patients underwent lumbar, and 11 patients underwent thoracolumbar procedures. In eight patients (21.6%), there was no resolution of SSEP signal changes despite intraoperative attempts. The two groups were similar with respect to age and co-morbidities including diabetes, ischemic heart disease, and peripheral arterial disease. There was also no significant difference in the mean BMI (p=0.22). The mean duration of the procedures was 324 minutes in the SSEP signal change patients and 260 minutes in the patients who did not experience SSEP signal changes (p=0.03). No patient with UE SSEP changes had a clinically detectable neurologic deficit postoperatively. CONCLUSIONS Upper extremity SSEP signal changes during multilevel posterior thoracolumbar procedures are more likely to occur as the duration of the operation increases. The presence of UE signal changes does not coincide with clinically significant peripheral neuropathies. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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