OBJECTIVE: To determine the use of multimodal intraoperative neurophysiological monitoring (IONM) during positioning procedures in cervical spine surgery. METHODS: IONM data was collected from 75 patients from the onset of positioning to the end of the surgical procedure. These included: transcranial motor evoked potentials (TcMEP), somatosensory evoked potentials (SEP) and free running electromyography (EMG) recordings. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (PNV) were calculated. RESULTS: IONM warnings were given in 5 cases during neck positioning. These consisted of the disappearance of TcMEP in all the cases, while two cases showed a loss of SEPs as well. Four of these patients presented a complete recovery of TcMEP and SEPs after neck repositioning. The patient in which this recovery was not present, woke up with new postoperative neurological deficits. Sensitivity, specificity, PPV and NPV of TcMEP during cervical positioning were all 100%. Sensitivity of SEPs was 40%; specificity and PPV were 100%; and the NPV of SEPs was 95.9%. CONCLUSION: Multimodal IONM is a useful method to prevent spinal cord injury during neck positioning in cervical spine surgical procedures. TcMEPs showed the highest sensitivity in detecting injuries to cervical spine related to neck positioning. SIGNIFICANCE: Multimodal IONM should not only be considered for detecting intra-operative warnings, but also during positioning.
OBJECTIVE: To determine the use of multimodal intraoperative neurophysiological monitoring (IONM) during positioning procedures in cervical spine surgery. METHODS: IONM data was collected from 75 patients from the onset of positioning to the end of the surgical procedure. These included: transcranial motor evoked potentials (TcMEP), somatosensory evoked potentials (SEP) and free running electromyography (EMG) recordings. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (PNV) were calculated. RESULTS: IONM warnings were given in 5 cases during neck positioning. These consisted of the disappearance of TcMEP in all the cases, while two cases showed a loss of SEPs as well. Four of these patients presented a complete recovery of TcMEP and SEPs after neck repositioning. The patient in which this recovery was not present, woke up with new postoperative neurological deficits. Sensitivity, specificity, PPV and NPV of TcMEP during cervical positioning were all 100%. Sensitivity of SEPs was 40%; specificity and PPV were 100%; and the NPV of SEPs was 95.9%. CONCLUSION: Multimodal IONM is a useful method to prevent spinal cord injury during neck positioning in cervical spine surgical procedures. TcMEPs showed the highest sensitivity in detecting injuries to cervical spine related to neck positioning. SIGNIFICANCE: Multimodal IONM should not only be considered for detecting intra-operative warnings, but also during positioning.
Authors: Anastasios Charalampidis; Fan Jiang; Jamie R F Wilson; Jetan H Badhiwala; Darrel S Brodke; Michael G Fehlings Journal: Global Spine J Date: 2020-01-06