title: Role of multimodal intraoperative neurophysiological monitoring during positioning of patient prior to cervical spine surgery.
abstract: OBJECTIVE
  To determine the use of multimodal intraoperative neurophysiological monitoring (IONM) during positioning procedures in cervical spine surgery.
  
  
  METHODS
  IONM data was collected from 75 patients from the onset of positioning to the end of the surgical procedure. These included: transcranial motor evoked potentials (TcMEP), somatosensory evoked potentials (SEP) and free running electromyography (EMG) recordings. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (PNV) were calculated.
  
  
  RESULTS
  IONM warnings were given in 5 cases during neck positioning. These consisted of the disappearance of TcMEP in all the cases, while two cases showed a loss of SEPs as well. Four of these patients presented a complete recovery of TcMEP and SEPs after neck repositioning. The patient in which this recovery was not present, woke up with new postoperative neurological deficits. Sensitivity, specificity, PPV and NPV of TcMEP during cervical positioning were all 100%. Sensitivity of SEPs was 40%; specificity and PPV were 100%; and the NPV of SEPs was 95.9%.
  
  
  CONCLUSIONS
  Multimodal IONM is a useful method to prevent spinal cord injury during neck positioning in cervical spine surgical procedures. TcMEPs showed the highest sensitivity in detecting injuries to cervical spine related to neck positioning.
  
  
  CONCLUSIONS
  Multimodal IONM should not only be considered for detecting intra-operative warnings, but also during positioning.
authors.affiliation: Hospital Universitario de Canarias (Department of Neurosurgery), S/C de Tenerife, Spain. Electronic address: jplata5@hotmail.com.
authors.forename: Julio
authors.initials: J
authors.lastname: Plata Bello
authors.affiliation: Hospital Universitario de Canarias (Intraoperative Neurophysiologic Monitoring Unit), S/C de Tenerife, Spain.
authors.forename: Pedro Javier
authors.initials: PJ
authors.lastname: Pérez-Lorensu
authors.affiliation: Hospital Universitario de Canarias (Department of Neurosurgery), S/C de Tenerife, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Roldán-Delgado
authors.affiliation: Hospital Universitario de Canarias (Department of Neurosurgery), S/C de Tenerife, Spain.
authors.forename: Liberto
authors.initials: L
authors.lastname: Brage
authors.affiliation: Hospital Universitario de Canarias (Department of Neurosurgery), S/C de Tenerife, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: Rocha
authors.affiliation: Hospital Universitario de Canarias (Department of Neurosurgery), S/C de Tenerife, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hernández-Hernández
authors.affiliation: Hospital Universitario de Canarias (Department of Neurosurgery), S/C de Tenerife, Spain.
authors.forename: Ayoze
authors.initials: A
authors.lastname: Dóniz
authors.affiliation: Hospital Universitario de Canarias (Department of Neurosurgery), S/C de Tenerife, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: García-Marín
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D004576:Electromyography / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011187:Posture / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000209:etiology / Q000517:prevention & control; D050781:Transcranial Magnetic Stimulation / Q000379:methods
keywords: Cervical spine surgery; Intraoperative neurophysiological monitoring; Neck positioning