title: Impact of multimodal intraoperative monitoring during correction of symptomatic cervical or cervicothoracic kyphosis.
abstract: OBJECTIVE
  surgical correction of symptomatic cervical or cervicothoracic kyphosis involves the potential for significant neurological complications. Intraoperative monitoring has been shown to reduce the risk of neurological injury in scoliosis surgery, but it has not been well evaluated during surgery for cervical or cervicothoracic kyphosis. In this article, the authors review a cohort of patients who underwent kyphosis correction with multimodal intraoperative monitoring (MIOM).
  
  
  METHODS
  twenty-nine patients were included in the study. Preoperative and postoperative Cobb angles were measured to determine the extent of correction. Multimodal intraoperative monitoring consisted of somatosensory evoked potentials, transcranial motor evoked potentials (tMEPs), and electromyography activity. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were assessed for each monitoring modality.
  
  
  RESULTS
  the mean patient age was 58.0 years, and 20 patients were female. The mean pre- and postoperative sagittal Cobb angles were 41.3° and 7.3°, respectively. A total of 8 intraoperative monitoring alerts were observed. Transcranial MEPs yielded a sensitivity of 75%, specificity of 84%, PPV of 43%, and NPV of 95%. Somatosensory evoked potentials had a sensitivity of 25%, specificity of 96%, PPV of 50%, and NPV of 88%. Electromyography resulted in a sensitivity of 0%, specificity of 93%, PPV of 0%, and NPV of 96%. Changes in tMEPs led to successful intervention in 2 cases. There was 1 case in which a C-8 palsy occurred without any changes in MIOM.
  
  
  CONCLUSIONS
  in contrast to sensitivity and PPV, specificity and NPV were generally high in all 3 monitoring modalities. Both false-positive and false-negative results occurred. Transcranial MEP monitoring was the most useful modality and appeared to allow successful intervention in certain cases. Larger, prospective comparative studies are necessary to determine whether MIOM truly decreases the rate of neurological complications and is therefore worth the added economic cost and intraoperative time.
authors.affiliation: Departments of Neurosurgery, University of Michigan, Ann Arbor, MIchigan 48109-5338, USA. ppark@umich.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Park
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Wang
authors.forename: Jaypal Reddy
authors.initials: JR
authors.lastname: Sangala
authors.forename: Sung Moon
authors.initials: SM
authors.lastname: Kim
authors.forename: Shawn
authors.initials: S
authors.lastname: Hervey-Jumper
authors.forename: Khoi D
authors.initials: KD
authors.lastname: Than
authors.forename: Amin
authors.initials: A
authors.lastname: Farokhrani
authors.forename: Frank
authors.initials: F
authors.lastname: Lamarca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D004558:Electric Stimulation; D004569:Electroencephalography / Q000379:methods*; D004576:Electromyography / Q000379:methods*; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D007738:Kyphosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010525:Peripheral Nerves / Q000503:physiopathology; D011237:Predictive Value of Tests; D011712:Pyramidal Tracts / Q000503:physiopathology; D013116:Spinal Cord / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000601:surgery*; D055815:Young Adult