title: Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy.
abstract: The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, UPMC Presbyterian-Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: thirumalapd@upmc.edu.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.affiliation: College of Literature, Science and the Arts, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Muralidharan
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Yoon K
authors.initials: YK
authors.lastname: Loke
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, UPMC Presbyterian-Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Habeych
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, UPMC Presbyterian-Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Crammond
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, UPMC Presbyterian-Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Balzer
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods; D004576:Electromyography; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D013118:Spinal Cord Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000503:physiopathology* / Q000601:surgery*; D055009:Spondylosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anterior cervical corpectomy; Anterior cervical decompression; Anterior cervical discectomy fusion; Anterior cervical interbody fusion; Cervical degenerative myelopathy; Cervical spondylotic myelopathy