Comparison of Three Approaches of Electrode Placement to Detect Changes in Motor Evoked Potentials During Spine Surgery

Allina Health System

Overview

Motor Evoked Potentials are an aspect of intraoperative neuromonitoring, a tool used by neurophysiologists during surgery to prevent irreversible damage to the spinal cord during procedures. This study investigates the utility of three separate quadriceps MEP recording approaches over a total of 40 limbs (20 participants).

The long-term objective of this research is to understand how differing recording techniques may enhance the ability to accurately identify clinically relevant changes in Motor Evoked Potentials (MEPs) during a variety of surgeries where the central motor tracts or lumbar spinal roots are at risk.The specific aims of the proposed research are: 1. Using transcranial magnetic stimulation, evaluate the effects on compound muscle action potentials utilizing intramuscular bipolar recording vs subdermal referential recordings vs subdermal bipolar recordings. 2. Evaluated the variability of amplitude and area between the intramuscular and subdermal recording techniques. The initial focus will be on recording techniques to obtain stable MEPs in a proximal lower limb muscle, specifically the quadriceps. Continuation research may focus on stimulation techniques to facilitate proximal MEPs and ultimately to improved specificity of MEP changes.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Conditions

Intervertebral Disc Degeneration Intervertebral Disc Displacement Spinal Stenosis Spinal Curvatures Spondylitis Spondylosis

Interventions

Quadriceps and Rectus Femoris MEP RecordingOTHER

Participants will receive additional electrodes placed intramuscularly to facilitate three separate approaches of quadriceps MEP recording

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients must be ≥18 years of age * Patients must be undergoing thoracic or lumbar spine surgery where quadriceps MEP recording would be the standard of care * Patients should have normal preoperative quadriceps strength * Patients are capable of understanding the informed consent and have signed the informed consent document prior to any study-specific screening procedures or evaluations being performed Exclusion Criteria: * Patients with ongoing psychiatric concerns would be excluded. * Patients who are non-English speakers.

Locations (1)

Abbott Northwestern Hospital

Minneapolis, Minnesota, United States

Outcomes

Primary Outcomes

Motor Evoked Potentials recorded with an Intramuscular bipolar electrodes in the Rectus Femoris

MEPs will be evoked throughout the duration of the surgery. MEPs will be recorded in the Rectus Femoris using intramuscular bipolar electrodes.

Time frame: Duration of surgery

Motor Evoked Potentials recorded with a subcutaneous referential electrodes in the Rectus Femoris

MEPs will be evoked throughout the duration of the surgery. Electrodes will be placed in the Rectus Femoris to serve as a reference.

Time frame: Duration of surgery

Motor Evoked Potentials recorded with secondary subcutaneous referential electrodes in the Rectus Femoris

MEPs will be evoked throughout the duration of the surgery. Electrodes will be placed in the Rectus Femoris to serve as a reference.

Time frame: Duration of surgery

Data from ClinicalTrials.gov

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