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Results find negative predictive value of intraoperative neurophysiological monitoring in spine surgery
SAN DIEGO — At the Congress for Neurological Surgeons Annual Meeting, a presenter noted intraoperative somatosensory evoked potentials monitoring in spine surgery had a strong negative predictive value.
“It can be reassuring if you do not find any changes, and [there is a] low probability of having a neurological deficit,” Matthew Pease, MD, said during his presentation. “In the future, a cost-utility analysis for intraoperative monitoring in spine should be undertaken to determine its cost-effectiveness.”
Pease and colleagues included about 4,500 patients who underwent spine surgery in their study. With the use of Bayesian techniques, the investigators determined the sensitivity and specificity of intraoperative neurophysiological monitoring to detect neurological deficits. They performed a subgroup analysis of patients who underwent posterior lumbar fusions and posterior cervical fusions. Pease and colleagues looked at length of surgery, patient demographics, BMI, history of smoking, degenerative myelopathy, hypertension, cardiovascular disease and the development of new neurodeficits. Investigators then determined whether the variables were positively or negatively correlated.
Investigators found of about 4,500 patients, 420 patients (about 10%) had significant intraoperative changes in the somatosensory evokes potentials (SSEPs). Pease said of these patients, 25 patients developed new postoperative deficits, with approximately 4,000 patients who did not develop postoperative deficits. He noted that of the patients who had no changes, 96 patients developed a new postoperative neurological deficit.
“As a reminder, during surgery if you find some type of SSEP changes, we did take corrective action to alleviate these [changes],” he said.
The entire cohort study showed a sensitivity of about 20% for the detection of new neurological deficits and a specificity of almost 91%. Pease said the technique was more accurate in the posterior cervical group, with a specificity of 94% compared with the posterior lumbar group which showed a specificity of 99%, but had a sensitivity of 18% for the detection of neurological deficits. – by Monica Jaramillo
Reference:
Pease M., et al. Paper #319. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 24-28, 2016; San Diego.
Disclosure: Pease reports no relevant financial disclosures.