• Go Yoshida, Hiroki Ushirozako, Shiro Imagama, Kazuyoshi Kobayashi, Kei Ando, Muneharu Ando, Shigenori Kawabata, Kei Yamada, Tsukasa Kanchiku, Yasushi Fujiwara, Shinichirou Taniguchi, Hiroshi Iwasaki, Hideki Shigematsu, Tsunenori Takatani, Nobuaki Tadokoro, Masahito Takahashi, Kanichiro Wada, Naoya Yamamoto, Masahiro Funaba, Akimasa Yasuda, Jun Hashimoto, Shinji Morito, Toshikazu Tani, and Yukihiro Matsuyama.
• Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
• Spine. 2022 Jul 15; 47 (14): 101810261018-1026.

Study DesignA prospective, multicenter study.ObjectiveTo evaluate the usefulness of transcranial motor-evoked potentials (Tc-MEPs) during supine-to-prone position change for thoracic ossification of the posterior longitudinal ligament (T-OPLL).Summary Of Background DataSupine-to-prone position change might be a risk of spinal cord injury in posterior decompression and fusion surgeries for T-OPLL.MethodsThe subjects were 145 patients with T-OPLL surgically treated with posterior decompression and fusion using Tc-MEPs in 14 institutes. Tc-MEPs were monitored before surgery from supine-to-prone position and intraoperatively in seven institutes and only intraoperatively in the other seven institutes because of disapproval of the anesthesia department. In cases of Tc-MEP alert after position change, we adjusted the cervicothoracic posture. When the MEP did not recover, we reverted the position to supine and monitored the Tc-MEPs in supine position.ResultsThere were 83 and 62 patients with/without Tc-MEP before position change to prone (group A and B). The true-positive rate was lower in group A than group B, but without statistical significance (8.4% vs. 16.1%, P = 0.12). In group A, five patients who had Tc-MEP alert during supine-to-prone position change were all female and had larger body mass index values and upper thoracic lesions. Among the patients, three underwent surgeries after cervicothoracic alignment adjustment, and two had postponed operations to 1 week later with halo-vest fixation because of repeated Tc-MEP alerts during position change to prone. The Tc-MEP alert at exposure was statistically more frequent in group B than in group A ( P = 0.033).ConclusionTc-MEP alert during position change is an important sign of spinal cord injury due to alignment change at the upper thoracic spine. Tc-MEP monitoring before supine-to-prone position change was necessary to prevent spinal cord injury in surgeries for T-OPLL.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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