Transcranial electric motor evoked potential monitoring during spine surgery: is it safe?

Spine (Phila Pa 1976). 2011 Jun;36(13):1046-9. doi: 10.1097/BRS.0b013e3181ecbe77.


Study design: Retrospective review.

Objective: To report on the safety of repetitive transcranial electric stimulation (RTES) for eliciting motor-evoked potentials during spine surgery.

Summary of background data: Theoretical concerns over the safety of RTES have hindered broader acceptance of transcranial electric motor-evoked potentials (tceMEP), despite successful implementation of spinal cord monitoring with tceMEPs in many large spine centers, as well as their apparent superiority over mixed-nerve somatosensory-evoked potentials (SSEP) for detection of spinal cord injury.

Methods: The records of 18,862 consecutive patients who met inclusion criteria and underwent spine surgery with tceMEP monitoring were reviewed for RTES-related complications.

Results: This large retrospective review identified only 26 (0.14%) cases with RTES-related complications; all but one of these were tongue lacerations, most of which were self-limiting.

Conclusions: The results demonstrate that RTES is a highly safe modality for monitoring spinal cord motor tract function intraoperatively.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Evoked Potentials, Motor*
  • Female
  • Humans
  • Infant
  • Lacerations
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / adverse effects
  • Monitoring, Intraoperative / methods*
  • Orthopedic Procedures* / adverse effects
  • Philadelphia
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Spinal Cord Injuries / diagnosis*
  • Spinal Cord Injuries / etiology
  • Spine / surgery*
  • Tongue / injuries
  • Transcranial Magnetic Stimulation* / adverse effects
  • Young Adult