Do Intraoperative Neurophysiological Changes During Decompressive Surgery for Cervical Myeloradiculopathy Affect Functional Outcome? A Prospective Study

Abstract

Study Design: Prospective cohort. Objective: To investigate whether intraoperative neuromonitoring (IONM) positive changes affect functional outcome after surgical intervention for myeloradiculopathy secondary to cervical compressive pathology (cervical compressive myelopathy). Methods: Twenty-eight patients who underwent cervical spine surgery with IONM for compressive myeloradiculopathy were enrolled. During surgery motor-evoked potential (MEP) and somatosensory evoked potential (SSEP) at baseline and before and after decompression were documented. A decrease in latency >10% or an increase in amplitude >50% was regarded as a “positive changes.” Patients were divided into subgroups based on IONM changes: group A (those with positive changes) and group B (those with no change or deterioration). Nurick grade and modified Japanese Orthopaedic Association (mJOA) score were evaluated before and after surgery. Results: Nine patients (32.1%) showed improvement in MEP. The mean preoperative Nurick grade and mJOA score of group A and B were (2.55 ± 0.83 and 11.11 ± 1.65) and (2.47 ± 0.7 and 11.32 ± 1.24), respectively. The mean postoperative Nurick grade of groups A and B at 6 months was 1.55 ± 0.74 and 1.63 ± 0.46, respectively, and this difference was not significant. The mean postoperative mJOA score of groups A and B at 6 months was 14.3 ± 1.03 and 12.9 ± 0.98, respectively, and this difference was statistically significant ( P = .011). Spearman correlation coefficient showed significant positive correlation between the IONM change and the mJOA score at 6 months postoperatively ( r = 0.47; P = .01). Conclusion: Our study shows that impact of positive changes in MEP during IONM reflect in functional improvement at 6 months postoperatively in cervical compressive myelopathy patients.

Letter to Editor on “Do Intraoperative Neurophysiological Changes During Decompressive Surgery for Cervical Myeloradiculopathy Affect Functional Outcome? A Prospective Study” by Akbari et al.

“…It was concluded that patients showing this had significant functional improvement at 6 months postoperatively compared to those without. 1 This was seen in contrast to our findings in 69 patients, whereby 100% improvement in MEP amplitude alone was evident in 53% receiving 5 pulses and 72% receiving 9 pulses with TES. We also demonstrated that supramaximal MEP amplitude was achieved with a lower TES intensity in the 9 pulse protocol compared to the 5 pulse protocol.…”

“…It was concluded that patients showing this had significant functional improvement at 6 months postoperatively compared to those without. 1 …”

Can Evoked Potential Changes during the Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery Predict Postoperative Improvement of Cerebral Perfusion and Functional Status?

“…Meanwhile, the role of IONM in predicting the patient’s postoperative recovery has also recently attracted attention, particularly in cervical decompression surgeries [ 17 , 18 ] and cerebral endovascular recanalization [ 19 ]. However, until now, few studies have been done on its ability to predict recovery post open cranial surgeries.…”