Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

Abstract

Abstract:Objective: The primary aim of this study is to conduct a systematic review of reports concerning patients with cervical spondylotic myelopathy to assess the value of intraoperative monitoring (IOM), such as SSEPs, TcMEPs, and EMG, in anterior cervical procedures. Methods: A search strategy was first conducted in order to collect a small database of relevant papers using key words describing both disorders and procedures of interest. The database was then shortlisted using selection criteria and data from these finalized reports was extracted to identify complications as a result of anterior cervical procedures treating cervical spondylotic myelopathy for outcome analysis on a continuous scale. Results: In the 22 studies that matched the screening criteria, only two involved the use of IOM. The 22 studies had an average of 173 patients. In studies with procedures done without IOM a mean change in JOA score of 3.94 points and a mean change in Nurick score by 1.20 points (both less severe post-op) were observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia had a mean outcome of 2.71% of cases for studies without IOM and a mean outcome of 0.91% of cases for studies with IOM. Conclusions: Based on the review of published studies sufficient evidence does not exist to negate or reinforce the use of IOM in hopes of reducing neurological complications during anterior cervical procedures. There is no standardized evaluation method to measure these complications. In addition, the modalities used for IOM have not been overwhelmingly confirmed.

The Forgotten Lateral Approach to the Upper Cervical Spine, Case Report

“…The development of the IOM has minimized postsurgical neurological complication [3]. The lateral approach presented here provides an excellent exposure of the lateral and ventral portions of the C1, C2 and C3 including the vertebral artery.…”

National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery

“…However, Zeng et al 23 failed to find a statistically significant association. Similarly, operative time was found to be a significant risk factor by some studies, 7,24,26,30,44 but other studies failed to identify it as one. 23,25,28 We found blood loss was associated with dysphagia (OR, 2.21; 95% CI, 1.41-3.48; p< 0.0006), although, as mentioned previously, this is likely due to confounding variables such as longer surgical time and more complex procedures.…”

“…Although dysphagia may be secondary to injury of the superior laryngeal, recurrent laryngeal, hypoglossal, or glossopharyngeal nerves, the efficacy and optimal modality of IOM in anterior cervical surgery remains unclear. Thirumala et al 44 and Ajiboye et al 45 failed to show evidence in support of IOM. Limitations in these meta-analyses include heterogeneity in the included studies, variability in the IOM modalities, and lack of standardization in IOM alert criteria.…”

The Significance of Motor Evoked Potential Changes and Utility of Multimodality Intraoperative Monitoring in Spinal Surgery: A Retrospective Analysis of Consecutive Cases at a Single Institution

“…IOM comprises three main categories: motor-evoked potentials (MEP), somatosensory-evoked potentials (SSEP), and electromyography (EMG) [6,7]. Recent literature has not clearly affirmed the value of IOM during spine surgery, nor the degree to which neurological outcomes are improved as a result of its use [8][9][10][11]. Most research on IOM focuses on the sensitivity and specificity of these modalities; however, the positive predictive value (PPV) and negative predictive value (NPV) may better characterize the information provided by IOM.…”