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Abstract
ObjectiveThe objective of the study is to identify specific population groups that may benefit from intraoperative motor evoked potentials (MEP) and to assess positive predictive value (PPV) and negative predictive value (NPV) changes during operation by correlating these with postoperative motor outcomes.MethodsWe retrospectively reviewed 1,043 consecutive patient cases undergoing spine surgery with and without intraoperative monitoring (IOM) at a single institution from January 1, 2016 to December 31, 2017. Demographic and clinical outcome data were collected at multiple time points. An MEP amplitude decrease of 50% or greater was correlated with a motor deficit for this study.ResultsOn multivariate analysis, patients with coronary artery disease and who received IOM were more likely to experience no new deficit (p=0.047) than those who did not receive IOM. Additionally, patients with hyperlipidemia and coronary artery disease (CAD) were less likely than those without to experience no new deficit (p=0.001 and p=0.02, respectively). MEP accounted for 244 cases, of which 15 had alert MEP criteria but no deficit for a PPV of 21.05% at day 1 post-operation. Day 7-30 PPV declined to 14.29%, and by day 90, there was no association.ConclusionAmong patients in our study with CAD, IOM use was associated with significantly better outcomes. Patients with higher intraoperative blood loss, hyperlipidemia, and those with CAD were at increased risk of new neurological deficit. The use of motor evoked potentials was associated with low sensitivity and low PPV.
Highlights
Neurological complications during spine surgery are rare and include direct spinal cord trauma and cord ischemia
motor evoked potentials (MEP) accounted for 244 cases, of which 15 had alert MEP criteria but no deficit for a positive predictive value (PPV) of 21.05% at day 1 post-operation
Our study demonstrates the significance of an intraoperative MEP change when considered in the context of the low prevalence of true neural element injury
Summary
Neurological complications during spine surgery are rare and include direct spinal cord trauma and cord ischemia. Such events are life-changing and can result in muscle weakness, pain, and even paralysis. The rate of intraoperative complications ranges from 0-3%. In spine surgeries of increased risk, such as intradural spinal cord tumors or spine deformity cases, intraoperative complications can be seen at much higher rates [1,2,3,4]. The method to detect intraoperative spinal cord injury was the Stagnara wake-up test, which required anesthetic reversal to observe gross motor function [5]. The subsequent introduction of intraoperative monitoring (IOM) has allowed for earlier detection of irritation and damage of neural elements
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