Key result
Intraoperative neuromonitoring is highly sensitive and specific for detecting neural damage, with a unilateral sustained decrease in MEP amplitude >80% serving as a reliable warning sign and a screw stimulation threshold <13 mA considered unsatisfactory.
Why the study?
The study was conducted to examine operating parameters of intraoperative monitoring and identify the sensitivity and specificity of its different modalities associated with postoperative neurological complications in patients with spinal pathologies.
Observational (n=88)
No
Intraoperative neuromonitoring modalities are highly sensitive and specific for detecting spinal cord and nerve damage, though external factors can cause false positives and negatives.
May guide neuromonitoring thresholds in spine surgery; hypothesis-generating pending randomized validation.
Objective. To study the operating parameters and phenomena of intraoperative monitoring and to identify the specificity and sensitivityof its different modalities associated with postoperative neurological complications in patients with different spinal pathologies.Methods. The intraoperative neurophysiological monitoring (IOM) protocols of 88 patients who underwent spinal surgeries were analyzed:kyphoscoliotic spinal deformities — 58 (68 %), traumatic — 12 (13.3 %), degenerative diseases — 10 (11.7 %), neoplasms — 6 (6.7 %). In 33 (38.4 %) cases, a combination of modalities of motor evoked potentials (MEP) and transpedicular screws stimulation (TSS) was used, in 36 (41.9%) — only MEP, 17 (19.8 %) — TSS. In all cases, freerun and triggered EMG was used. Results. The most stable MEPs were recorded at mm. tibibalis anterior, mm. abductor hallucis longus. It has been proven that an unfavorable and reliable factor of the anxiety sign is a unilateral sustained decrease in the MEP amplitude by more than 80 %. According to the TSS results 424 (97.5 %) screws are installed correctly, 1 (0.2 %) false negative case of incorrect installation. False positive results for the TSS test ranged from 34.7 to 15.4 %, depending on the chosen critical threshold of the current applied to the pedicle screw. We consider the threshold of the TSS test at 13 mA satisfactory, and below it, unsatisfactory. A group of patients was identified who had 72 screws (16.6% of all analyzed) who, according to the results of the TSS test, received an unsatisfactory assessment, and X-ray did not reveal any deviations in the position of the screws.Conclusions. IOM modalities are highly sensitive and specific to damage to the structures of the spinal cord and spinal nerves, but dependence on a number of external factors reduces their information content, which leads to false positive and false negative results. It was established, that the dynamics of the MEP amplitudes of the target muscles differs in information content and efficiency during surgery due to individual morphological and motor characteristics.
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Barkov et al. (2022) conducted an observational in Spinal pathologies (kyphoscoliotic deformities, traumatic, degenerative diseases, neoplasms) (n=88). Intraoperative neurophysiological monitoring (MEP and TSS) was evaluated on Diagnostic accuracy (sensitivity and specificity) of IOM modalities for detecting neurological complications and incorrect screw placement. Intraoperative neuromonitoring is highly sensitive and specific for detecting neural damage, with a unilateral sustained decrease in MEP amplitude >80% serving as a reliable warning sign and a screw stimulation threshold <13 mA considered unsatisfactory.
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