Optimal stimulation intensity for Br(E)-MsEP waveform derivation at baseline in pediatric spinal surgery

• Published in: Clinical neurology and neurosurgery 2019-05, Vol.180, p.74-78
• Main Authors: Kobayashi, Kazuyoshi, Ando, Kei, Machino, Masaaki, Ota, Kyotaro, Morozumi, Masayoshi, Tanaka, Satoshi, Kanbara, Shunsuke, Ito, Sadayuki, Ishiguro, Naoki, Imagama, Shiro
• Format: Article
• Language: English
• Subjects: Adults; Age; Anesthesia; Back surgery; Blood pressure; Body mass index; Body temperature; Br(E)-MsEP; Children; Congenital diseases; Disease; Extremities; Muscles; Neurology; Optimal stimulation; Patients; Pediatric; Pediatrics; Pyramidal tracts; Scoliosis; Spinal cord; Spinal cord injuries; Spine surgery; Stimulation; Stimulation intensity; Surgery; Thoracic surgery
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2019.03.005

•Optimal stimulation intensity for derivation of Br(E)-MsEP waveforms for spinal surgery of pediatric patients was examined.•A baseline waveform was obtained in 85 pediatric patients and Br(E)-MsEP responses were obtained from 1437/1513 muscles.•The mean stimulation intensity was 156.4 mA and the stimulation intensity was significantly correlated with age.•Starting at a lower stimulation strength than that used for adult patients is appropriate for younger children.•Our data provide a starting point for development of standardized criteria for Br(E)-MsEP waveforms in pediatric patients. Br(E)-MsEP monitoring is widely used in spinal surgery for detection of spinal cord injury. However, Br(E)-MsEP waveform derivation requires high-intensity stimulation, and this raises a concern of adverse effects due to the immature corticospinal tract in pediatric patients. The purpose of this study is to determine the optimal stimulation intensity required for derivation of Br(E)-MsEP waveforms at baseline in pediatric spinal surgery. The subjects were 85 pediatric patients (4–15 years old, mean age at surgery: 11.1 years old) who were treated with spinal surgery using a posterior only approach under Br(E)-MsEP monitoring. The main diagnoses were adolescent idiopathic scoliosis (n = 44), syndromic and neuromuscular scoliosis (n = 23), and congenital scoliosis (n = 12). A total of 1513 muscles in the lower extremities were chosen for monitoring. A baseline waveform was obtained in all 85 cases and baseline Br(E)-MsEP responses were obtained from 1437/1513 muscles (95%). The mean stimulation intensity for baseline waveform derivation was 156.4 mA (range: 100–200 mA), and the stimulation intensity was significantly correlated with age (p