title: Evidence-based guideline update:  intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials*.
abstract: OBJECTIVE
  To evaluate whether spinal cord intraoperative monitoring (IOM) with somatosensory and transcranial electrical motor evoked potentials (EPs) predict adverse surgical outcomes.
  
  
  METHODS
  A panel of experts reviewed the results of a comprehensive literature search and identified published studies relevant to the clinical question. These studies were classified according to the evidence-based methodology of the American Academy of Neurology. Objective outcomes of postoperative onset of paraparesis, paraplegia, and quadriplegia were used because no randomized or masked studies were available.
  
  
  CONCLUSIONS
  Four class I and eight class II studies met inclusion criteria for analysis. The four class I studies and seven of the eight class II studies reached significance in showing that paraparesis, paraplegia, and quadriplegia occurred in the IOM patients with EP changes compared with the IOM group without EP change. All studies were consistent in showing all occurrences of paraparesis, paraplegia, and quadriplegia in the IOM patients with EP changes, with no occurrences of paraparesis, paraplegia, and quadriplegia in patients without EP change. In the class I studies, 16% to 40% of the IOM patients with EP changes developed postoperative-onset paraparesis, paraplegia, or quadriplegia. IOM is established as effective to predict an increased risk of the adverse outcomes of paraparesis, paraplegia, and quadriplegia in spinal surgery (four class I and seven class II studies). Surgeons and other members of the operating team should be alerted to the increased risk of severe adverse neurologic outcomes in patients with important IOM changes (level A).
authors.affiliation: Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles, CA, USA.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Nuwer
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Emerson
authors.forename: Gloria
authors.initials: G
authors.lastname: Galloway
authors.forename: Alan D
authors.initials: AD
authors.lastname: Legatt
authors.forename: Jaime
authors.initials: J
authors.lastname: Lopez
authors.forename: Robert
authors.initials: R
authors.lastname: Minahan
authors.forename: Thoru
authors.initials: T
authors.lastname: Yamada
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Goodin
authors.forename: Carmel
authors.initials: C
authors.lastname: Armon
authors.forename: Vinay
authors.initials: V
authors.lastname: Chaudhry
authors.forename: Gary S
authors.initials: GS
authors.lastname: Gronseth
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Harden
mesh_terms: D019317:Evidence-Based Medicine; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D013116:Spinal Cord / Q000502:physiology / Q000601:surgery*