Intraoperative electromyographic activation has a high sensitivity for the detection of a newpostoperative neurologic deficit but a low specificity. In contrast, somatosensory-evoked potentials have low sensitivity but high specificity. Combined intraoperative neurophysiologic monitoring with electromyography and somatosensory-evoked potentials is helpful for predicting and possibly preventing neurologic injury during thoracolumbar spine surgery.
To our knowledge, this is the largest series to date reporting the use of multimodality intraoperative neurophysiologic monitoring in the surgical management of adult tethered cord syndrome. Posterior tibial nerve SSEPs have high specificity, but low sensitivity, for predicting new neurologic deficits. In contrast, continuous EMG showed high sensitivity and low specificity. Evoked EMG accurately identified functional neural tissue. The combined recording of SSEPs in concert with continuous and evoked EMGs may provide a useful adjunct to complex microsurgery for adult tethered cord syndrome.
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