• Kohshi Hattori, Kenji Yoshitani, Shinya Kato, Masahiko Kawaguchi, Mikito Kawamata, Manabu Kakinohana, Yoshitsugu Yamada, Michiaki Yamakage, Kimitoshi Nishiwaki, Shunsuke Izumi, Yusuke Yoshikawa, Yoshiteru Mori, Kazuko Hasegawa, and Yoshihiko Onishi.
• National Cerebral and Cardiovascular Center, Osaka, Japan.
• J. Cardiothorac. Vasc. Anesth. 2019 Jul 1; 33 (7): 1835-1842.

ObjectivesThe authors investigated the association between intraoperative motor-evoked potential (MEP) changes and the severity of spinal cord infarction diagnosed with magnetic resonance imaging (MRI) to clarify the discrepancy between them, which was observed in patients with postoperative motor deficits after thoracic and thoracoabdominal aortic surgery.DesignA multicenter retrospective study.SettingMotor-evoked potential <25% of control values was deemed positive for spinal cord ischemia. The severity of spinal cord infarction was categorized into grades A to D based on previous studies using the most severe axial MRI slices. The associations between MRI grade, MEP changes, and motor deficits were examined using logistic regression.ParticipantsTwenty-three of 1,245 patients (from 1999 to 2013, at 12 hospitals in Japan) were extracted from medical records of patients who underwent thoracic and thoracoabdominal aortic repair, with intraoperative MEP examinations and postoperative spinal MRI.InterventionsNo intervention (observational study).Measurements And Main ResultsMotor-evoked potential <25% of control value was associated significantly with motor deficits at discharge (adjusted odds ratio [OR], 130.0; p = 0.041), but not with severity of spinal cord infarction (adjusted OR, 0.917; p = 0.931). Motor deficit at discharge was associated with severe spinal cord infarction (adjusted OR, 4.83; p = 0.043), MEP <25% (adjusted OR, 13.95; p = 0.031), and combined deficits (motor and sensory, motor and bowel or bladder, or sensory and bowel or bladder deficits; adjusted OR, 31.03; p = 0.072) in stepwise logistic regression analysis.ConclusionMotor-evoked potential <25% was associated significantly with motor deficits at discharge, but not with the severity of spinal cord infarction.Copyright © 2018 Elsevier Inc. All rights reserved.

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