title: Diagnostic Accuracy of Somatosensory Evoked Potentials in Evaluating New Neurological Deficits After Posterior Cervical Fusions.
abstract: METHODS
  This study examined the diagnostic accuracy of significant changes of somatosensory evoked potentials (SSEPs) to evaluate and predict postoperative neurological deficits after posterior cervical fusions (PCF). Eight hundred forty six eligible patients underwent PCF at the University of Pittsburgh Medical Center (UPMC), from 2010 to 2012.
  
  
  OBJECTIVE
  To assess the specificity and sensitivity of intraoperative monitoring in predicting postoperative neurological deficits during PCF.
  
  
  BACKGROUND
  We calculated the predictive value, including sensitivity and specificity, of changes in SSEPs to identify neurological deficits postoperatively. We used a receiver operating characteristic (ROC) curve with SSEP categories as cutoff values to further evaluate the diagnostic accuracy of change in SSEPs and postoperative neurological deficit.
  
  
  METHODS
  All patients had preposition baselines and continuous SSEP monitoring throughout the surgery. Statistical analysis was completed using SPSS version 22 (IBM Corp., Armonk, NY).
  
  
  RESULTS
  Age and sex did not influence outcomes. Obesity affected patient outcome. The SSEP categories of significant changes and loss of responses resulted in a sensitivity/specificity of 0.30/0.96 and 0.16/0.98, respectively. The receiver operating characteristic curve has an area under the curve for significant change in/loss of SSEPs of 0.62/0.65 with a 95% confidence interval of 0.525 to 0.714/0.509 to 0.797.
  
  
  CONCLUSIONS
  Significant SSEP changes during PCF are a very specific but poorly sensitive indicator of postoperative neurological deficits. The odds ratio for significant changes in SSEPs and loss of waveforms was 9.80 and 11.82, respectively, with a 95% confidence interval of 4.695 to 20.46 and 4.45 to 31.41, respectively.
  
  
  METHODS
  1.
authors.affiliation: Department of Neurological Surgery, Pittsburgh, PA.|Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.affiliation: Department of Neurological Surgery, Pittsburgh, PA.|Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Samyuktha R
authors.initials: SR
authors.lastname: Melachuri
authors.affiliation: Department of Neurological Surgery, Pittsburgh, PA.|Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Kaur
authors.affiliation: Department of Neurological Surgery, Pittsburgh, PA.|Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: David
authors.initials: D
authors.lastname: Ninaci
authors.affiliation: Department of Neurological Surgery, Pittsburgh, PA.|Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Manasa K
authors.initials: MK
authors.lastname: Melachuri
authors.affiliation: Department of Neurological Surgery, Pittsburgh, PA.|Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Miguel E
authors.initials: ME
authors.lastname: Habeych
authors.affiliation: Department of Neurological Surgery, Pittsburgh, PA.|Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Crammond
authors.affiliation: Department of Neurological Surgery, Pittsburgh, PA.|Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Balzer
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards*; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000639:trends