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Diagnostic Accuracy of Combined Multimodality Somatosensory Evoked Potential and Transcranial Motor Evoked Potential Intraoperative Monitoring in Patients With Idiopathic Scoliosis

Thirumala, Parthasarathy D. MD, MS; Huang, Jessie BS; Thiagarajan, Karthy MB; Cheng, Hannah BS; Balzer, Jeffrey PhD; Crammond, Donald J. PhD

doi: 10.1097/BRS.0000000000001678
Literature Review

Study Design. Systematic review.

Objective. The aim of the study was to determine the predictive value of combined multimodality somatosensory evoked potential (SSEP) and transcranial motor evoked potential (TcMEP) monitoring in detecting impending neurological injury during surgery for idiopathic scoliosis.

Summary of Background Data. The diagnostic of motor evoked potential monitoring and SSEP monitoring have been established. However, the predictive value of combined multimodality SSEP and TcMEP monitoring in detecting impending neurological injury during surgery for idiopathic scoliosis has not been evaluated.

Methods. A systematic literature search was performed using PubMed/MEDLINE, Web of Science, and EMBASE from 1974 to January 2015. All titles and abstracts were independently reviewed by the authors. We included all studies that were (1) randomized controlled trials, prospective or retrospective cohort studies; (2) included patients with idiopathic scoliosis undergoing scoliosis correction surgery; (3) included multimodality SSEP and TcMEP monitoring during spinal surgery; (4) included immediate postoperative neurological assessment; (5) idiopathic scoliosis patient population n ≥25; and (6) published in English.

Results. Seven studies comprising a total of 2052 patients with idiopathic scoliosis were included in our meta-analysis. The incidence of neurological deficit in this cohort was 0.93%. The pooled sensitivity, specificity, and Diagnostic Odds Ratio were 82.6% (95% CI 56.7%–94.5%), 94.4% (95% CI 85.1%–98.0%), and 106.16 (95% CI 24.952–451.667), respectively. The area under the curve was 0.928, indicating excellent discriminatory ability.

Conclusion. Idiopathic scoliosis corrective surgery patients who experience a new neurological deficit are 106.16 times more likely to have had an SSEP and/or TcMEP change during corrective procedures. The results of this meta-analysis demonstrate that combined multimodality SSEP and TcMEP monitoring possess some advantage over use of each alone, and that intraoperative neurophysiological monitoring may provide a valuable biomarker in detection of impending neurological injury.

Level of Evidence: 2

*Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA

Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA.

Address correspondence and reprint requests to Parthasarathy D. Thirumala, MD, MS, Center for Clinical Neurophysiology, Department of Neurologic Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian-Suite-B-400, 200 Lothrop Suite, Pittsburgh, PA 15213; E-mail: thirumalapd@upmc.edu

Received 14 October, 2015

Revised 28 January, 2016

Accepted 22 February, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.