Comparative Sensitivity of Intraoperative Motor Evoked Potential Monitoring in Predicting Postoperative Neurologic Deficits: Nondegenerative versus Degenerative Myelopathy

Clark, Aaron J.; Safaee, Michael; Chou, Dean; Weinstein, Philip; Clark, John Patrick; Mummaneni, Praveen V.

doi:10.1055/s-0035-1565258

Cited by 13 publications

(6 citation statements)

References 18 publications

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“…9 The accuracy of MEPs in detecting potential neurological injury has been demonstrated by several studies. Clark et al 36 reported a sensitivity of 71% and a specificity of 94% in predicting postoperative deficits in patients undergoing operative procedures for degenerative cervical myelopathy. In 2004, Hilibrand et al 12 compared the use of both SSEP and tcMEP monitoring in 427 consecutive patients who underwent cervical spine surgery.…”

Section: The Use Of Ionm During Cervical Spine Surgerymentioning

confidence: 99%

The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery

Charalampidis

Jiang

Wilson

et al. 2020

Global Spine Journal

102

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Study Design: Narrative review. Objective: To summarize relevant studies regarding the utilization of intraoperative neurophysiological monitoring (IONM) techniques in spine surgery implemented in recent years. Methods: A literature search of the Medline database was performed. Relevant studies from all evidence levels have been included. Titles, abstracts, and reference lists of key articles were included. Results: Multimodal intraoperative neurophysiological monitoring (MIONM) has the advantage of compensating for the limitations of each individual technique and seems to be effective and accurate for detecting perioperative neurological injury during spine surgery. Conclusion: Although there are no prospective studies validating the efficacy of IONM, there is a growing body of evidence supporting its use during spinal surgery. However, the lack of validated protocols to manage intraoperative alerts highlights a critical knowledge gap. Future investigation should focus on developing treatment methodology, validating practice protocols, and synthesizing clinical guidelines.

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Section: The Use Of Ionm During Cervical Spine Surgerymentioning

confidence: 99%

The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery

Charalampidis

Jiang

Wilson

et al. 2020

Global Spine Journal

102

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“…[12][13][14][15] The most important aims of IONM are to prevent intraoperative nerve injury, facilitate more alert interventions, and safely complete surgery. The sensitivity of Tc(E)-MEPs is higher for DCM than for non-DCM 16 ; however, its effectiveness in cervical spondylotic myelopathy (CSM) and cervical OPLL has not yet been directly compared. OPLL is more susceptible to perioperative paralysis than CSM, [17][18][19] and the benefits of IONM for OPLL have already been demonstrated.…”

mentioning

confidence: 99%

Efficacy of Intraoperative Neuromonitoring Using Transcranial Motor-Evoked Potentials for Degenerative Cervical Myelopathy

Funaba

Kanchiku

Yoshida

et al. 2021

Spine

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Study Design. A prospective multicenter observational study. Objective. To elucidate the efficacy of transcranial motor-evoked potentials (Tc(E)-MEPs) in degenerative cervical myelopathy (DCM) surgery by comparing cervical spondylotic myelopathy (CSM) to cervical ossification of the posterior longitudinal ligament (OPLL) and investigate the timing of Tc(E)-MEPs alerts and types of interventions affecting surgical outcomes. Summary of Background Data. Although CSM and OPLL are the most commonly encountered diseases of DCM, the benefits of Tc(E)-MEPs for DCM remain unclear and comparisons of these two diseases have not yet been conducted. Methods. We examined the results of Tc(E)-MEPs from 1176 DCM cases (840 CSM /336 OPLL) and compared patients background by disease, preoperative motor deficits, and the type of surgical procedure. We also assessed the efficacy of interventions based on Tc(E)-MEPs alerts. Tc(E)-MEPs alerts were defined as an amplitude reduction of more than 70% below the control waveform. Rescue cases were defined as those in which waveform recovery was achieved after interventions in response to alerts and no postoperative paralysis. Results. Overall sensitivity was 57.1%, and sensitivity was higher with OPLL (71.4%) than with CSM (42.9%). The sensitivity of acute onset segmental palsy including C5 palsy was 40% (OPLL/CSM: 66.7%/0%) whereas that of lower limb palsy was 100%. The most common timing of Tc(E)-MEPs alerts was during decompression (63.16%), followed by screw insertion (15.79%). The overall rescue rate was 57.9% (OPLL/CSM: 58.3%/57.1%). Conclusion. Since Tc(E)-MEPs are excellent for detecting long tract injuries, surgeons need to consider appropriate interventions in response to alerts. The detection of acute onset segmental palsy by Tc(E)-MEPs was partially possible with OPLL, but may still be difficult with CSM. The rescue rate was higher than 50% and appropriate interventions may have prevented postoperative neurological complications. Level of Evidence: 3

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“…The sensitivity of IONM was calculated to be 75% and specificity 98%, with differences depending on patient age and comorbidities as well as increased sensitivity in patients with preoperative motor deficits. A follow-up study by Clark et al 20 in 144 patients compared 102 patients with degenerative CSM and 42 patients with nondegenerative causes (24 extra-axial tumors, 12 infectious processes, 5 traumatic fractures, and 1 rheumatoid arthritis) who had IONM used during their surgery. For degenerative versus nondegenerative cases, a sensitivity/specificity of 71%/94% versus 33%/74% was identified respectively.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intraoperative Neuromonitoring during the Treatment of Cervical Myelopathy

Gamblin

Awad

Karsy

et al. 2023

Indian Journal of Neurosurgery

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Objective The accuracy of intraoperative neuromonitoring (IONM) during surgery for cervical spondylotic myelopathy (CSM) to detect iatrogenic nervous system injuries while they are reversible remains unknown. We evaluated a cohort of patients who had IONM during surgery to assess accuracy. Methods Patients who underwent surgical treatment of CSM that included IONM from January 2018 through August 2018 were retrospectively identified. A standardized protocol was used for operative management. Clinical changes and postoperative neurological deficits were evaluated. Results Among 131 patients in whom IONM was used during their procedure, 42 patients (age 58.2 ± 16.3 years, 54.8% males) showed IONM changes and 89 patients had no change. The reasons for IONM changes varied, and some patients had changes detected via multiple modalities: electromyography (n = 25, 59.5%), somatosensory-evoked potentials (n = 14, 33.3%), motor evoked potentials (n = 13, 31.0%). Three patients, all having baseline deficits before surgery, had postoperative deficits. Among the 89 patients without an IONM change, 4 showed worsened postoperative deficits, which were also seen at last follow-up. The sensitivity of IONM for predicting postoperative neurological change was 42.86% and the specificity was 68.55%. However, most patients (124, 94.7%) in whom IONM was used showed no worsened neurological deficit. Conclusions IONM shows potential in ensuring stable postoperative neurological outcomes in most patients; however, its clinical use and supportive guidelines remain controversial. In our series, prediction of neurological deficits was poor in contrast to some previous studies. Further refinement of clinical and electrophysiological variables is needed to uniformly predict postoperative neurological outcomes.

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Comparative Sensitivity of Intraoperative Motor Evoked Potential Monitoring in Predicting Postoperative Neurologic Deficits: Nondegenerative versus Degenerative Myelopathy

Cited by 13 publications

References 18 publications

The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery

The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery

Efficacy of Intraoperative Neuromonitoring Using Transcranial Motor-Evoked Potentials for Degenerative Cervical Myelopathy

Efficacy of Intraoperative Neuromonitoring during the Treatment of Cervical Myelopathy

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