The effect of intra and extra surgical factors on the efficacy of intraoperative neuromonitoring during cervical spine surgery.

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The effect of intra and extra surgical factors on the efficacy of intraoperative neuromonitoring during cervical spine surgery.

World Neurosurg. 2018 Dec 18;:

Authors: Appel S, Biron T, Goldstein K, Ashkenazi E

Abstract
INTRODUCTION: The purpose of this study was to examine the effect of various extra and intraoperative factors on the ability of neuromonitoring to predict neurological complications.
METHODS: We reviewed the data of 592 patients who underwent cervical spine surgery with neuromonitoring at Assuta Medical Center between 2006-2013. We compared somatosensory evoked potentials (SSEPs), transcranial electric motor evoked potentials (tcMEPs), and electromyography (EMG) data collected throughout the surgery to patient surgical outcome measures, demographics and pre-existing pathologies determined by neurologic examination and radiographic image study findings. Descriptive and inferential analyses were used to estimate the relative explanatory power contributed by these factors.
RESULTS: 468 patients were included in the study. Neuromonitoring change occurred in 100 patients and the appropriate clinical intervention was undertaken in all these patients with recovery of the signals in 69 patients. Transient neuromonitoring change was not associated with poor outcome (only in 8/69 patients) where permanent neuromonitoring change was associated with new neurological deficit. (13/31 of the patients) Changes occurring during positioning or decompression were associated with better clinical outcome compared to changes occurring during the rest of the procedure. Extra operative factors were not associated with an increased risk for neuromonitoring change during the surgery or to poorer surgical outcome.
CONCLUSIONS: Permanent neuromonitoring change predicts new neurological deficit where transient changes were not associated with a new deficit. Neuromonitoring change occurring during positioning and decompression had better clinical outcome compared to those occurring during the rest of the procedure.

PMID: 30576814 [PubMed - as supplied by publisher]

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