Somatosensory Evoked Potentials as a Stand-Alone Tool During Spine Surgery: An Egyptian Preliminary Report

Abstract

Purpose: Monitoring of somatosensory evoked potentials (SSEPs) serves as an early warning system to detect spinal cord injury and is correlated with postoperative sensory findings. It is an indirect indicator of motor function. This study aimed to evaluate the usefulness of intraoperative SSEPs monitoring as a stand-alone tool during spinal surgeries when motor evoked potentials are not available, to prevent and predict new postoperative neurologic deficits. Motor evoked potentials were not used as the equipment needed to record them was not available at the time of this study. Methods: This study included 50 patients, aged 14 to 67 years, undergoing extramedullary manipulations, decompression of an epidural abscess or neoplasm, removal of intramedullary tumor, or arteriovenous malformation or spine correction procedures. Somatosensory evoked potentials were analyzed for latency and peak-to-peak amplitude. Critical SSEP changes were defined as a 50% decrease in amplitude or a 10% increase in latency. Results: Somatosensory evoked potentials had an overall sensitivity of 81.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 91.3%. Conclusions: Intraoperative SSEPs have proved to be highly sensitive and specific for iatrogenic injury, mechanical stress caused by cord traction/compression, dural traction, lowered systemic blood pressure, and cord hypothermia. The reversibility of intraoperative SSEP changes showed a highly significant relation to the number of cases with new postoperative deficits as well as type and site of pathologic study (P = 0.00, P = 0.01, and P = 0.00, respectively) but not with the level of pathologic study (P = 0.49).

Accuracy of Intraoperative Neuromonitoring in the Diagnosis of Intraoperative Neurological Decline in the Setting of Spinal Surgery—A Systematic Review and Meta-Analysis

“…Details related to excluded studies, including reasons for exclusion, are presented in Supplementary Table 1 . A total of 164 studies 2 , 5 , 42 – 52 , 52 – 62 , 62 – 72 , 72 – 82 , 82 – 92 , 92 – 102 , 102 – 112 , 112 – 122 , 122 – 132 , 132 – 142 , 142 – 152 , 152 – 162 , 162 – 172 , 172 – 182 , 182 – 192 , 192 – 203 consisting of 99937 patients were included. Of the 164 studies, 16 (9.75%) were prospective while 148 (90.25%) were retrospective.…”

Application of Controlled Hypotension During Surgery for Spinal Metastasis

“…EMG and motor evoked potentials (MEPs) are more sensitive methods to monitor these injuries. 64 A combination of MEP and SSEP has been shown to increase the sensitivity of SSEP from 59% to 92%. 65 Therefore, a combination of MEP and SSEP for multimode monitoring of the spinal tract is a more effective and reasonable method.…”

Intelligent Integration of Assessment Tools for Specialized Prognosis in Spinal Cord Injuries: A scoping review

“…The current clinical evaluations of SCI are limited in their ability to predict outcomes and guide therapeutic decisions. As a result, there is an increasing need for more sophisticated assessments and the development of biomarkers that can complement current clinical measurements (Furthermore, neurophysiological techniques such as measuring nerve conduction, motor evoked potentials, and SSEPs provide objective measures of neural integrity and allow differentiation between demyelination and axonal damage(Li et al 2021;Abdelkader et al 2019…”