title: Diagnostic accuracy of somatosensory evoked potential monitoring during scoliosis fusion.
abstract: The goal of this review was to ascertain the diagnostic accuracy of intraoperative somatosensory evoked potential (SSEP) changes to predict perioperative neurological outcome in patients undergoing spinal deformity surgery to correct adolescent idiopathic scoliosis (AIS). The authors searched PubMed/MEDLINE and World Science databases to retrieve reports and/or experiments from January 1950 through January 2014 for studies on SSEP use during AIS surgery. All motor and sensory deficits were noted in the neurological examination administered after the procedure which was used to determine the effectiveness of SSEP as an intraoperative monitoring technique. Fifteen studies identified a total of 4763 procedures on idiopathic patients. The observed incidence of neurological deficits was 1.11% (53/4763) of the sample population. Of the patients with new postoperative neurological deficits 75.5% (40/53) showed significant SSEP changes, and 24.5% (13/53) did not show significant change. Pooled analysis using the bivariate model showed SSEP change with pooled sensitivity (average 84%, 95% confidence interval 59-95%) and specificity (average 98%, 95% confidence interval 97-99%). The diagnostic odds ratio of a patient who had a new neurological deficit with SSEP changes was a diagnostic odds ratio of 340 (95% confidence interval 125-926). Overall, detection of SSEP changes had excellent discriminant ability with an area under the curve of 0.99. Our meta-analysis covering 4763 operations on idiopathic patients showed that it is a highly sensitive and specific test and that iatrogenic spinal cord injury resulting in new neurological deficits was 340 times more likely to have changes in SSEP compared to those without any new deficits.
authors.affiliation: Department of Neurologic Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian-Suite-B-400, 200 Lothrop Suite, Pittsburgh, PA 15213, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: thirumalapd@upmc.edu.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.affiliation: Department of Neurologic Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian-Suite-B-400, 200 Lothrop Suite, Pittsburgh, PA 15213, USA.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Cheng
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 Neurologic Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian-Suite-B-400, 200 Lothrop Suite, Pittsburgh, PA 15213, USA.
authors.forename: D
authors.initials: D
authors.lastname: Kojo Hamilton
authors.affiliation: Department of Neurologic Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian-Suite-B-400, 200 Lothrop Suite, Pittsburgh, PA 15213, USA; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Balzer
authors.affiliation: Department of Neurologic Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian-Suite-B-400, 200 Lothrop Suite, Pittsburgh, PA 15213, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Crammond
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D016017:Odds Ratio; D012372:ROC Curve; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000209:etiology; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*
keywords: Idiopathic scoliosis; Intraoperative neurophysiological monitoring; Somatosensory evoked potential