Diagnostic and prognostic significance of preoperative evoked potential tests in degenerative cervical myelopathy

Abstract

BACKGROUND CONTEXTDecompression surgery is a treatment option for patients with degenerative cervical myelopathy (DCM). Surgical decisions primarily depend on clinical symptoms and radiological examinations. The diagnostic and prognostic significance of evoked potential tests for surgical outcomes in patients with DCM has not been thoroughly examined. PURPOSETo identify the diagnostic and prognostic significance of preoperative evoked potential tests in patients with DCM who underwent decompression surgery. STUDY DESIGNThis was a retrospective observational study. PATIENT SAMPLEOne hundred two consecutive patients who underwent evoked potential tests and surgical treatment between January 2016 and December 2020 in a single spine center and had a minimum follow-up of 6 months. OUTCOME MEASURESJapanese Orthopedic Association (JOA) scores obtained preoperatively and 6 months after surgery. METHODSThis study evaluated the preoperative central motor conduction time (CMCT), somatosensory evoked potentials, and Japanese Orthopedic Association (JOA) scores obtained preoperatively and 6 months after surgery. RESULTSAbnormal CMCT findings were observed in 94 patients (92.2%). Abnormal somatosensory evoked potentials were observed in 77 patients (75.5%). There was a statistically significant correlation between preoperative JOA score and abductor pollicis brevis (APB)-CMCT (r=−0.546, p=.001), tibialis anterior (TA)-CMCT (r=−0.517, p<.001), median nerve (MN)-SSEP (r=−0.353, p=.001), and tibial nerve (TN)-SSEP (r=−0.349, p=.003). There were significant differences in recovery rates associated with diabetes mellitus (DM), preoperative severity of myelopathy, TA-CMCT, MN-SSEP, and TN-SSEP. Stepwise multiple regression analysis showed that the major factors affecting the clinical outcomes were TN-SSEP (β=0.327, p=.004), preoperative JOA score (β=0.278, p=.012), and DM (β=0.241, p=.025). CONCLUSIONSEvoked potential testing is a functional diagnostic tool that can indicate the severity of myelopathic symptoms in patients with DCM. Additionally, preoperative TN-SSEP may have significant prognostic value in predicting postoperative clinical outcomes. Thus, preoperative evoked potential tests could be helpful for determining suitable surgical treatment candidates and forecasting postoperative prognosis.