title: Somatosensory- and motor-evoked potential monitoring without a wake-up test during idiopathic scoliosis surgery. An accepted standard of care.
abstract: METHODS
  This was a retrospective study of 500 patients undergoing corrective surgery between 1987 and 1997 for spinal deformity caused by idiopathic scoliosis.
  
  
  OBJECTIVE
  To report the sensitivity and specificity of somatosensory-evoked and neurogenic motor-evoked potentials monitoring and the requirements for an intraoperative wake-up test for all idiopathic scoliosis surgeries at a single institution.
  
  
  BACKGROUND
  Intraoperative monitoring is recommended for use during corrective spinal surgery. Accepted monitoring standards and requirements for an intraoperative wake-up test are still debated.
  
  
  METHODS
  The study group consisted of 500 patients undergoing corrective surgery for idiopathic scoliosis between 1987 and 1997. All patients were monitored using somatosensory-evoked and neurogenic motor-evoked potential techniques, using a standard protocol developed at this institution.
  
  
  RESULTS
  The false-positive rate (significant data change without postoperative neurologic deficit) was 0.014% (n = 7). The true-positive rate (degradation of data that met warning criteria, with a corresponding postoperative neurologic deficit) was 0.004% (n = 2). No false-negative results (normal data during with a postoperative neurologic deficit) were seen. The sensitivity of combined somatosensory-evoked and neurogenic motor-evoked potential data in predicting neurologic status was 98.6%, and the specificity of normal data predicting normal findings in a neurologic examination was 100%.
  
  
  CONCLUSIONS
  Combined somatosensory-evoked and neurogenic motor-evoked potentials monitoring during idiopathic scoliosis surgery represents a standard of care that obviates the need for an intraoperative wake-up test when reliable data are obtained and maintained.
authors.affiliation: Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, Missouri, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Padberg
authors.forename: T J
authors.initials: TJ
authors.lastname: Wilson-Holden
authors.forename: L G
authors.initials: LG
authors.lastname: Lenke
authors.forename: K H
authors.initials: KH
authors.lastname: Bridwell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005189:False Positive Reactions; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D012680:Sensitivity and Specificity