Motor Evoked Potential Recordings from the Urethral Sphincter Muscles (USMEPs) during Spine Surgeries
November 25, 2024
Faisal R. Jahangiri, M.D., CNIM, D.ABNM, FASNM1 ; Justin W. Silverstein, D.H.Sc., CNIM2 ; Courtney Trausch, B.S.3 ; Sami Al Eissa, M.D.4 ; Zachariah M. George, M.D.5 ; Hargovind DeWal, M.D.6 ; Izabela Tarasiewicz, M.D., FRCS (C)7
1 Axis Neuromonitoring LLC Richardson, Texas; 2 Neuro Protective Solutions Hauppauge, New York; 3 Department of Applied Cognition and Neuroscience University of Texas Richardson, Texas; 4 Division of Orthopedics, Department of Surgery King Abdulaziz Medical City Riyadh, Saudi Arabia; 5 Neurological Surgery PC Rockville Centre, New York; 6 Long Island Spine Specialists West Islip, New York; 7 Department of Neurosurgery University of Texas Health Science Center San Antonio, Texas
Citation:
Faisal R. Jahangiri, Justin W. Silverstein, Courtney Trausch, Sami Al Eissa, Zachariah M. George, Hargovind DeWal & Izabela Tarasiewicz (2019) Motor Evoked Potential Recordings from the Urethral Sphincter Muscles (USMEPs) during Spine Surgeries, The Neurodiagnostic Journal, 59:1, 34-44, DOI: 10.1080/21646821.2019.1572375
ABSTRACT
Bowel and bladder function are at risk during tumor resection of the conus, cauda equina, and nerve roots. This study demonstrates the ability to acquire transcranial electrical motor evoked potentials (TCeMEPs) from the urethral sphincter muscles (USMEPs) by utilizing a urethral catheter with an embedded electrode. A retrospective analysis of intraoperative neurophysiological monitoring (IONM) data from nine intradural tumors, four tethered cord releases, and two spinal stenosis procedures was performed (n = 15). The cohort included seven females and eight males (median age: 38.91 years). A catheter with embedded urethral electrodes was used for recording TCeMEPs and spontaneous electromyograph (s-EMG) from the external urethral sphincter (EUS). USMEPs were obtained in 14 patients (93%). The reliability of TCeMEP from the external anal sphincter (EAS) was variable across all patients. In patient 7, the TCeMEP recordings from the urethral sphincter were not present before incision; however, following the resection of the tumor, the USMEP recordings were obtained and remained stable for the remainder of the procedure. Patient 7 had subsequent improvement in bladder function postoperatively. Patient 4 exhibited a 50% increase in the amplitude of the USMEP following tumor resection and exhibited improved bladder function as well postoperatively. In this small series, we were able to acquire consistent and reliable MEPs when recorded from the urethral sphincters. More study is needed to establish a better understanding of the value added by this modality. USMEPs can be attempted in surgeries that put the function of the pelvic floor at risk.
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