Date of Submission
5-2024
Document Type
Thesis
Degree Name
Doctor of Health Science
Department
Health Sciences
First Advisor
Yanice V. Méndez-Fernández, Ph.D.,MPH
Second Advisor
Justin Silverstein, DHSc., CNIM
Third Advisor
Karl Minges, Ph.D., MPH
MeSH
Bipolar Disorder, Spine, General Surgery, Neurophysiology
LCSH
Bipolar disorder, Spine--Surgery, Neurophysiology
Abstract
Problem: Linked quadripolar stimulation (LQP) is a technique used within the field of intraoperative neurophysiology to elicit a transcranial motor evoked potential (TcMEP). However, the technique has not been experimentally validated as being superior in eliciting TcMEPs or reducing patient movement during surgery. LQP also incurs higher supply costs, increased set up times, and increases the risk of needle stick injury and infection; because the technique requires the use of more needle electrodes than more traditional approaches.
Purpose: TcMEPs are a practice regularly employed by surgical neurophysiologists and vital in the assessment of corticospinal tract, nerve root, and nerve function during various surgical procedures. Patient movement is an unfortunate byproduct of TcMEP stimulation and can often pose a challenge during surgery. LQP is a recent innovation presented at conferences and claims several advantages over the traditional Bipolar (BP) stimulation. This study aims to compare BP and LQP stimulation to validate the effectiveness of LQP.
Methods: A retrospective chart review of 30 patients was conducted to compare LQP and BP techniques. Following institutional review board approval, a comprehensive analysis of standard response criteria for each technique on available patient data was performed. The Mann-Whitney U test was performed to compare patient movement and compound muscle action potential (CMAP) amplitude, and area under the curve values (AUC) for data collected using LQP and BP techniques; p < .05. The Pearson correlation coefficient was used to assess relationships between the observed variables; p < .05. In all cases, the neuromonitoring was performed by a singular board-certified neurophysiologist.
Results: The study sample consisted of 30 patients consisting of 14 males and 16 females (mean age: 55, range: 29-86). A Mann-Whitney U test was used to compare patient movement, amplitude, and AUC values between BP and LQP stimulation approaches, and showed no statistically significant difference in any variable. A Pearson Correlation test was used to evaluate the relationship between patient movement and stimulation intensity, and amplitude and AUC values. No correlation was found between patient movement and stimulation; however, a strong correlation (>.7) was found in all comparisons between amplitude and AUC.
Conclusion: No statistically significant difference was observed across patient movement, amplitude, or AUC values between LQP and BP stimulation. Contrary to suggestions made in the limited research available about LQP practices, LQP did not demonstrate reduced movement or improved CMAP data. Due to the increased cost, safety concerns for the neurophysiologist, and set-up time required, and lack of evidence indicating benefits over BP stimulation, future research is warranted and clinicians may consider the use of BP to improve care practices.
Recommended Citation
Haddad, Joseph, "A Comparative Effectiveness Study of Bipolar and Linked Quadripolar Techniques for Eliciting Transcranial Motor Evoked Potentials During Spine Surgery" (2024). Health Science Doctoral Thesis. 8.
https://digitalcommons.newhaven.edu/healthscidocthesis/8