2022 Volume 13 Issue 2 Pages 87-95
Introduction: Postoperative new neurologic defects are one of the complications to avoid regarding spinal cord surgery. This study aimed to observe: 1) waveform changes and postoperative neurologic deficits in multimodal intraoperative neuromonitoring (IONM) and 2) the effects of the interventions performed in response to these events.
Methods: This retrospective study included 272 patients who underwent adult spinal deformity surgery with multimodal IONM from April 2016 to September 2020. Transcranial motor evoked potentials (TcMEP), free-run electromyography (fEMG), short latency somatosensory evoked potentials (SSEP), timing of alerts, and interventions at waveform changes were reviewed. All the patients were reassessed for new neurologic deficits during the postoperative period and followed up based on the intraoperative findings and neurologic deficits.
Results: Of the 272 patients being monitored continuously during the intraoperative period, 22 of TcMEP, 5 of fEMG, 30 of TcMEP and fEMG, and 1 of TcMEP and SSEP showed alerts. The interventions included interruption of surgical operation, decompression, removing the rod, adjusting the anesthesia, increasing the blood pressure, and blood transfusion. Of the 30 patients (11 of TcMEP, 1 of TcMEP and SSEP, 18 of TcMEP and fEMG) whose IONM showed waveform change even after bailout intervention, postoperative neurologic deficits were seen in 17 of the 30 (56.7%) patients (6.3% of all the cases). The multimodal IONM used in this study had a sensitivity of 100%, specificity of 92.9%, positive predictive value of 48.6%, and negative predictive value of 100%.
Conclusions: Postoperative new neurologic deficits may be avoided via appropriate alerts and interventions using multimodal IONM.
