Neuromonitoring in cervical spine surgery: when is a signal drop clinically significant?

Study design: Retrospective cohort study. Purpose: To identify the clinical significance of different patterns of intraoperative neuromonitoring (IONM) signal alerts. Overview of literature: IONM is a long-established valuable adjunct to complex spine surgeries. IONM for cervical spine surgery...

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Main Authors: Decruz, Joshua, Kaliya-Perumal, Arun-Kumar, Wong, Kevin Ho-Yin, Kumar, Dinesh Shree, Yang, Eugene Weiren, Oh, Jacob Yoong-Leong
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2024
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Online Access:https://hdl.handle.net/10356/175680
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spelling sg-ntu-dr.10356-1756802024-05-05T15:39:32Z Neuromonitoring in cervical spine surgery: when is a signal drop clinically significant? Decruz, Joshua Kaliya-Perumal, Arun-Kumar Wong, Kevin Ho-Yin Kumar, Dinesh Shree Yang, Eugene Weiren Oh, Jacob Yoong-Leong Lee Kong Chian School of Medicine (LKCMedicine) Tan Tock Seng Hospital Medicine, Health and Life Sciences Cervical vertebrae Electrophysiological phenomena Study design: Retrospective cohort study. Purpose: To identify the clinical significance of different patterns of intraoperative neuromonitoring (IONM) signal alerts. Overview of literature: IONM is a long-established valuable adjunct to complex spine surgeries. IONM for cervical spine surgery is in the form of somatosensory evoked potential (SSEP) and motor evoked potential (MEP). The efficacy of both modalities (individually or in combination) to detect clinically significant neurological compromise is constantly being debated and requires conclusive suggestions. Methods: Clinical and neuromonitoring data of 207 consecutive adult patients who underwent cervical spine surgeries at multiple surgical centers using bimodal IONM were analyzed. Signal changes were divided into three groups. Group 0 had transient signal changes in either MEPs or SSEPs, group 1 had sustained unimodal changes, and group 2 had sustained changes in both MEPs and SSEPs. The incidences of true neurological deficits in each group were recorded. Results: A total of 25% (52/207) had IONM signal alerts. Out of these signal drops, 96% (50/52) were considered to be false positives. Groups 0 and 1 had no incidence of neurological deficits, while group 2 had a 29% (2/7) rate of true neurological deficits. The sensitivities of both MEP and SSEP were 100%. SSEP had a specificity of 96.6%, while MEP had a lower specificity at 76.6%. C5 palsy rate was 6%, and there was no correlation with IONM signal alerts (p=0.73). Conclusions: This study shows that we can better predict its clinical significance by dividing IONM signal drops into three groups. A sustained, bimodal (MEP and SSEP) signal drop had the highest risk of true neurological deficits and warrants a high level of caution. There were no clear risk factors for false-positive alerts but there was a trend toward patients with cervical myelopathy. Published version 2024-05-03T00:42:27Z 2024-05-03T00:42:27Z 2021 Journal Article Decruz, J., Kaliya-Perumal, A., Wong, K. H., Kumar, D. S., Yang, E. W. & Oh, J. Y. (2021). Neuromonitoring in cervical spine surgery: when is a signal drop clinically significant?. Asian Spine Journal, 15(3), 317-323. https://dx.doi.org/10.31616/asj.2020.0074 1976-1902 https://hdl.handle.net/10356/175680 10.31616/asj.2020.0074 3 15 317 323 en Asian Spine Journal Ⓒ 2021 by Korean Society of Spine Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Medicine, Health and Life Sciences
Cervical vertebrae
Electrophysiological phenomena
spellingShingle Medicine, Health and Life Sciences
Cervical vertebrae
Electrophysiological phenomena
Decruz, Joshua
Kaliya-Perumal, Arun-Kumar
Wong, Kevin Ho-Yin
Kumar, Dinesh Shree
Yang, Eugene Weiren
Oh, Jacob Yoong-Leong
Neuromonitoring in cervical spine surgery: when is a signal drop clinically significant?
description Study design: Retrospective cohort study. Purpose: To identify the clinical significance of different patterns of intraoperative neuromonitoring (IONM) signal alerts. Overview of literature: IONM is a long-established valuable adjunct to complex spine surgeries. IONM for cervical spine surgery is in the form of somatosensory evoked potential (SSEP) and motor evoked potential (MEP). The efficacy of both modalities (individually or in combination) to detect clinically significant neurological compromise is constantly being debated and requires conclusive suggestions. Methods: Clinical and neuromonitoring data of 207 consecutive adult patients who underwent cervical spine surgeries at multiple surgical centers using bimodal IONM were analyzed. Signal changes were divided into three groups. Group 0 had transient signal changes in either MEPs or SSEPs, group 1 had sustained unimodal changes, and group 2 had sustained changes in both MEPs and SSEPs. The incidences of true neurological deficits in each group were recorded. Results: A total of 25% (52/207) had IONM signal alerts. Out of these signal drops, 96% (50/52) were considered to be false positives. Groups 0 and 1 had no incidence of neurological deficits, while group 2 had a 29% (2/7) rate of true neurological deficits. The sensitivities of both MEP and SSEP were 100%. SSEP had a specificity of 96.6%, while MEP had a lower specificity at 76.6%. C5 palsy rate was 6%, and there was no correlation with IONM signal alerts (p=0.73). Conclusions: This study shows that we can better predict its clinical significance by dividing IONM signal drops into three groups. A sustained, bimodal (MEP and SSEP) signal drop had the highest risk of true neurological deficits and warrants a high level of caution. There were no clear risk factors for false-positive alerts but there was a trend toward patients with cervical myelopathy.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Decruz, Joshua
Kaliya-Perumal, Arun-Kumar
Wong, Kevin Ho-Yin
Kumar, Dinesh Shree
Yang, Eugene Weiren
Oh, Jacob Yoong-Leong
format Article
author Decruz, Joshua
Kaliya-Perumal, Arun-Kumar
Wong, Kevin Ho-Yin
Kumar, Dinesh Shree
Yang, Eugene Weiren
Oh, Jacob Yoong-Leong
author_sort Decruz, Joshua
title Neuromonitoring in cervical spine surgery: when is a signal drop clinically significant?
title_short Neuromonitoring in cervical spine surgery: when is a signal drop clinically significant?
title_full Neuromonitoring in cervical spine surgery: when is a signal drop clinically significant?
title_fullStr Neuromonitoring in cervical spine surgery: when is a signal drop clinically significant?
title_full_unstemmed Neuromonitoring in cervical spine surgery: when is a signal drop clinically significant?
title_sort neuromonitoring in cervical spine surgery: when is a signal drop clinically significant?
publishDate 2024
url https://hdl.handle.net/10356/175680
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