False negative and positive motor evoked potentials in one patient: Is single motor evoked potential monitoring reliable method?: A case report and literature review

Jae-Young Hong, Seung-Woo Suh, Hitesh N. Modi, Chang Yong Hur, Hae Ryong Song, Jong Hoon Park

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Study Design: A case report and literature review. Objective: To report a false negative and delayed positive motor-evoked potential (MEP) in 1 patient. Summary of background data: An unreliable MEP can result in fatal outcomes because surgeons have recently begun to depend on the MEP for intraoperative decision-making. Methods: We report a case of a false MEP during scoliosis surgery that showed false negative and positive MEPs during a series of operations. Results: A 23-year-old man with a history of spondyloepiphyseal dysplasia presented with severe kyphoscoliosis. The initial neurologic examination did not reveal any neurologic abnormalities. Surgical correction and fusion were performed with transcranial MEP monitoring. During the entire procedure, the MEP did not reveal any signs of cord injury. However, lower limb paralysis and paresthesia was observed when the patient awakened. After 2 additional surgical procedures to recover the neurologic deficit, the MEP did not show any signs of cord injury but the patient's neurologic status had recovered slightly. At postoperative day 8, the neurologic status recovered, and a third operation was performed to fix the long rods. However, there were abnormal amplitudes in both lower limbs but the patient's neurologic status was almost normal. Conclusion: From our experience of false negative and positive MEP in 1 patient, it is concluded that undesirable events can occur with use of MEP in scoliosis or other spinal surgery. Therefore, we warn the surgeons too heavily rely on the MEP monitoring, and propose a further prospective study as well as use of alternative method that can improve the reliability of single MEP.

Original languageEnglish
JournalSpine
Volume35
Issue number18
DOIs
Publication statusPublished - 2010 Aug 15

Fingerprint

Motor Evoked Potentials
Nervous System
Scoliosis
Osteochondrodysplasias
Nervous System Malformations
Fatal Outcome
Paresthesia
Paraplegia
Wounds and Injuries
Neurologic Examination
Neurologic Manifestations
Lower Extremity
Decision Making
Prospective Studies

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

@article{dbaca8d7f0544d65b99c131e26f1636e,
title = "False negative and positive motor evoked potentials in one patient: Is single motor evoked potential monitoring reliable method?: A case report and literature review",
abstract = "Study Design: A case report and literature review. Objective: To report a false negative and delayed positive motor-evoked potential (MEP) in 1 patient. Summary of background data: An unreliable MEP can result in fatal outcomes because surgeons have recently begun to depend on the MEP for intraoperative decision-making. Methods: We report a case of a false MEP during scoliosis surgery that showed false negative and positive MEPs during a series of operations. Results: A 23-year-old man with a history of spondyloepiphyseal dysplasia presented with severe kyphoscoliosis. The initial neurologic examination did not reveal any neurologic abnormalities. Surgical correction and fusion were performed with transcranial MEP monitoring. During the entire procedure, the MEP did not reveal any signs of cord injury. However, lower limb paralysis and paresthesia was observed when the patient awakened. After 2 additional surgical procedures to recover the neurologic deficit, the MEP did not show any signs of cord injury but the patient's neurologic status had recovered slightly. At postoperative day 8, the neurologic status recovered, and a third operation was performed to fix the long rods. However, there were abnormal amplitudes in both lower limbs but the patient's neurologic status was almost normal. Conclusion: From our experience of false negative and positive MEP in 1 patient, it is concluded that undesirable events can occur with use of MEP in scoliosis or other spinal surgery. Therefore, we warn the surgeons too heavily rely on the MEP monitoring, and propose a further prospective study as well as use of alternative method that can improve the reliability of single MEP.",
author = "Jae-Young Hong and Seung-Woo Suh and Modi, {Hitesh N.} and Hur, {Chang Yong} and Song, {Hae Ryong} and Park, {Jong Hoon}",
year = "2010",
month = "8",
day = "15",
doi = "10.1097/BRS.0b013e3181d8fabb",
language = "English",
volume = "35",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "18",

}

TY - JOUR

T1 - False negative and positive motor evoked potentials in one patient

T2 - Is single motor evoked potential monitoring reliable method?: A case report and literature review

AU - Hong, Jae-Young

AU - Suh, Seung-Woo

AU - Modi, Hitesh N.

AU - Hur, Chang Yong

AU - Song, Hae Ryong

AU - Park, Jong Hoon

PY - 2010/8/15

Y1 - 2010/8/15

N2 - Study Design: A case report and literature review. Objective: To report a false negative and delayed positive motor-evoked potential (MEP) in 1 patient. Summary of background data: An unreliable MEP can result in fatal outcomes because surgeons have recently begun to depend on the MEP for intraoperative decision-making. Methods: We report a case of a false MEP during scoliosis surgery that showed false negative and positive MEPs during a series of operations. Results: A 23-year-old man with a history of spondyloepiphyseal dysplasia presented with severe kyphoscoliosis. The initial neurologic examination did not reveal any neurologic abnormalities. Surgical correction and fusion were performed with transcranial MEP monitoring. During the entire procedure, the MEP did not reveal any signs of cord injury. However, lower limb paralysis and paresthesia was observed when the patient awakened. After 2 additional surgical procedures to recover the neurologic deficit, the MEP did not show any signs of cord injury but the patient's neurologic status had recovered slightly. At postoperative day 8, the neurologic status recovered, and a third operation was performed to fix the long rods. However, there were abnormal amplitudes in both lower limbs but the patient's neurologic status was almost normal. Conclusion: From our experience of false negative and positive MEP in 1 patient, it is concluded that undesirable events can occur with use of MEP in scoliosis or other spinal surgery. Therefore, we warn the surgeons too heavily rely on the MEP monitoring, and propose a further prospective study as well as use of alternative method that can improve the reliability of single MEP.

AB - Study Design: A case report and literature review. Objective: To report a false negative and delayed positive motor-evoked potential (MEP) in 1 patient. Summary of background data: An unreliable MEP can result in fatal outcomes because surgeons have recently begun to depend on the MEP for intraoperative decision-making. Methods: We report a case of a false MEP during scoliosis surgery that showed false negative and positive MEPs during a series of operations. Results: A 23-year-old man with a history of spondyloepiphyseal dysplasia presented with severe kyphoscoliosis. The initial neurologic examination did not reveal any neurologic abnormalities. Surgical correction and fusion were performed with transcranial MEP monitoring. During the entire procedure, the MEP did not reveal any signs of cord injury. However, lower limb paralysis and paresthesia was observed when the patient awakened. After 2 additional surgical procedures to recover the neurologic deficit, the MEP did not show any signs of cord injury but the patient's neurologic status had recovered slightly. At postoperative day 8, the neurologic status recovered, and a third operation was performed to fix the long rods. However, there were abnormal amplitudes in both lower limbs but the patient's neurologic status was almost normal. Conclusion: From our experience of false negative and positive MEP in 1 patient, it is concluded that undesirable events can occur with use of MEP in scoliosis or other spinal surgery. Therefore, we warn the surgeons too heavily rely on the MEP monitoring, and propose a further prospective study as well as use of alternative method that can improve the reliability of single MEP.

UR - http://www.scopus.com/inward/record.url?scp=77955929629&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955929629&partnerID=8YFLogxK

U2 - 10.1097/BRS.0b013e3181d8fabb

DO - 10.1097/BRS.0b013e3181d8fabb

M3 - Article

C2 - 20956881

AN - SCOPUS:77955929629

VL - 35

JO - Spine

JF - Spine

SN - 0362-2436

IS - 18

ER -