Somatosensory evoked potential monitoring during anterior cervical discectomy and fusion.
METHODS
A retrospective, multicenter clinical review was conducted.


OBJECTIVE
To examine our experience using somatosensory evoked potential (SSEP) monitoring during anterior cervical discectomy and fusion (ACDF) to determine if monitoring of the spinal cord with SSEPs was helpful in identifying reversible causes of neurologic impairment while performing the procedure.


BACKGROUND
Recent studies have strongly supported the use of SSEP monitoring during complicated and upper-cervical spine surgery.


METHODS
The complete medical records of 163 patients who underwent ACDF, and who were monitored with SSEPs during the procedure between 1995 and 2002 were retrospectively reviewed. A single observer who was uninvolved with patient care abstracted these medical records. Demographic data, length of symptoms, workers' compensation status, primary diagnosis, preoperative neurologic status, number of levels fused, bone graft type, implants used, SSEP findings, postoperative neurologic status, complications, and recovery from complications were recorded. Final neurologic status was determined through phone contact with patients or outpatient charts of patients who could not be contacted personally.


RESULTS
There were 3 false positive (1.8%) intraoperative SSEP findings in which SSEP changes intraoperatively did not reflect a neurologic deterioration after surgery. There was 1 false negative (0.6%) in which a new neurologic deficit occurred after surgery, despite no change in SSEP amplitudes during the operation. There were 2 true negatives (1.2%) in which SSEP monitoring showed a preexisting neurologic deficit, which did not change during the operation.


CONCLUSIONS
In no instance were positive SSEP findings clinically useful in alerting the surgeon to potential intraoperative complications. Intraoperative SSEP monitoring is not helpful to the surgeon when performing routine ACDF. Additionally, ACDF is a safe procedure with a low rate of neurologic complications.
Taunt
Charles J
CJ
Department of Orthopaedic Surgery, St. John Oakland Hospital, Madison Heights, MI, USA. chiptaunt@hotmail.com
Sidhu
Kanwaldeep S
KS
Andrew
Shane A
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects; D004568:Electrodiagnosis / Q000592:standards; D005073:Evoked Potentials, Somatosensory; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015337:Multicenter Studies as Topic; D009333:Neck; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D011843:Radiculopathy / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013123:Spinal Fusion