title: Significance of multimodal intraoperative monitoring for the posterior cervical spine surgery.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of multimodal neurophysiologic intra-operative monitoring (IOM) in a cohort of patients who underwent posterior cervical surgery.
  
  
  METHODS
  A total 182 patients were included in this study. Multi-modal intraoperative monitoring (MIOM, somatosensory-evoked potentials: SSEP/transcranial motor-evoked potentials: TCe-MEP/spontaneous-electromyography: S-EMG) was performed in a consecutive series of 129 patients and the other 53 patients (control group) did not. We classified all patients into a high-cervical (H-C) operation group or a low-cervical (L-C) operation group, based on the level of the surgery and analyzed respectively.
  
  
  RESULTS
  One hundred-eleven cases (86%) showed true negative results. Fourteen patients (9 cases- H-C operation, 5 cases- L-C operation) met the criteria of neurophysiologic changes during operation. Of these, 10 cases were restored to normal during operation spontaneously (7 cases) or with surgical manipulation (all 3 cases were related to H-C operation). All unrestored neurophysiologic cases (n=4) showed new post-operative neurological deficits. Four patients showed neurological deficits without any changes in MIOM (false negative, 3 cases--delayed onset C5 palsy, 1 case--C8 palsy).
  
  
  CONCLUSIONS
  Proper application of MIOM may be useful to detect intraoperative neurological injury during the posterior cervical operations and improve surgical outcomes especially in subgroup of H-C operation. However, the efficacy of MIOM may be restricted to detect and prevent the delayed onset C5 palsy.
authors.affiliation: Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea.
authors.forename: Il Sup
authors.initials: IS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Sung
authors.affiliation: Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea. Electronic address: jatagi15@paran.com.
authors.forename: Jae Taek
authors.initials: JT
authors.lastname: Hong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; 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*; D012189:Retrospective Studies
keywords: High cervical operation; Low cervical operation; Multi-modal intraoperative monitoring; Posterior cervical spine surgery