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Title: The Utility of Transcranial Stimulated Motor-Evoked Potential Alerts in Cervical Spine Surgery Varies Based on Preoperative Motor Status.
Author: Funaba M, Kanchiku T, Kobayashi K, Yoshida G, Machino M, Yamada K, Shigematsu H, Tadokoro N, Ushirozako H, Takahashi M, Yamamoto N, Morito S, Kawabata S, Fujiwara Y, Ando M, Taniguchi S, Iwasaki H, Wada K, Yasuda A, Hashimoto J, Takatani T, Ando K, Matsuyama Y, Imagama S.
Journal: Spine (Phila Pa 1976); 2022 Dec 01; 47(23):1659-1668. PubMed ID: 35943242.
Abstract:
STUDY DESIGN: A prospective multicenter observational study. OBJECTIVE: The aim was to investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in cervical spine surgery and identify factors associated with positive predictive value when Tc-MEP alerts are occurred. SUMMARY OF BACKGROUND DATA: The sensitivity and specificity of Tc-MEP for detecting motor paralysis are high; however, false-positives sometimes occur. MATERIALS AND METHODS: The authors examined Tc-MEP in 2476 cases of cervical spine surgeries and compared patient backgrounds, type of spinal disorders, preoperative motor status, surgical factors, and the types of Tc-MEP alerts. Tc-MEP alerts were defined as an amplitude reduction of more than 70% from the control waveform. Tc-MEP results were classified into two groups: false-positive and true-positive, and items that showed significant differences were extracted by univariate analysis and detected by multivariate analysis. RESULTS: Overall sensitivity was 66% (segmental paralysis: 33% and lower limb paralysis: 95.8%) and specificity was 91.5%. Tc-MEP outcomes were 33 true-positives and 233 false-positives. Positive predictive value of general spine surgery was significantly higher in cases with a severe motor status than in a nonsevere motor status (19.5% vs . 6.7%, P =0.02), but not different in high-risk spine surgery (20.8% vs . 19.4%). However, rescue rates did not significantly differ regardless of motor status (48% vs . 50%). In a multivariate logistic analysis, a preoperative severe motor status [ P =0.041, odds ratio (OR): 2.46, 95% confidence interval (95% CI): 1.03-5.86] and Tc-MEP alerts during intradural tumor resection ( P <0.001, OR: 7.44, 95% CI: 2.64-20.96) associated with true-positives, while Tc-MEP alerts that could not be identified with surgical maneuvers ( P =0.011, OR: 0.23, 95% CI: 0.073-0.71) were associated with false-positives. CONCLUSION: The utility of Tc-MEP in patients with a preoperative severe motor status was enhanced, even in those without high-risk spine surgery. Regardless of the motor status, appropriate interventions following Tc-MEP alerts may prevent postoperative paralysis.

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