title: Diagnostic accuracy of motor evoked potentials to detect neurological deficit during idiopathic scoliosis correction: a systematic review.
abstract: OBJECTIVE The goal of this study was to evaluate the efficacy of intraoperative transcranial motor evoked potential (TcMEP) monitoring in predicting an impending neurological deficit during corrective spinal surgery for patients with idiopathic scoliosis (IS). METHODS The authors searched the PubMed and Web of Science database for relevant lists of retrieved reports and/or experiments published from January 1950 through October 2014 for studies on TcMEP monitoring use during IS surgery. The primary analysis of this review fit the operating characteristic into a hierarchical summary receiver operating characteristic curve model to determine the efficacy of intraoperative TcMEP-predicted change. RESULTS Twelve studies, with a total of 2102 patients with IS were included. Analysis found an observed incidence of neurological deficits of 1.38% (29/2102) in the sample population. Of the patients who sustained a neurological deficit, 82.8% (24/29) also had irreversible TcMEP change, whereas 17.2% (5/29) did not. The pooled analysis using the bivariate model showed TcMEP change with sensitivity (mean 91% [95% CI 34%-100%]) and specificity (mean 96% [95% CI 92-98%]). The diagnostic odds ratio indicated that it is 250 times more likely to observe significant TcMEP changes in patients who experience a new-onset motor deficit immediately after IS correction surgery (95% CI 11-5767). TcMEP monitoring showed high discriminant ability with an area under the curve of 0.98. CONCLUSIONS A patient with a new neurological deficit resulting from IS surgery was 250 times more likely to have changes in TcMEPs than a patient without new deficit. The authors' findings from 2102 operations in patients with IS show that TcMEP monitoring is a highly sensitive and specific test for detecting new spinal cord injuries in patients undergoing corrective spinal surgery for IS. They could not assess the value of TcMEP monitoring as a therapeutic adjunct owing to the limited data available and their study design.
authors.affiliation: Departments of 1 Neurological Surgery and.|Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Crammond
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
authors.forename: Yoon K
authors.initials: YK
authors.lastname: Loke
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Cheng
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Jessie
authors.initials: J
authors.lastname: Huang
authors.affiliation: Departments of 1 Neurological Surgery and.|Neuroscience, University of Pittsburgh.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Balzer
mesh_terms: D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D016343:Monitoring, Intraoperative / Q000379:methods; D019635:Neurosurgical Procedures; D012600:Scoliosis / Q000175:diagnosis / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000601:surgery*
keywords: BAEP = brainstem auditory evoked potential; IS = idiopathic scoliosis; MEP = motor evoked potential; ROC = receiver operating characteristic; SSEP = somatosensory evoked potential; TcMEP = transcranial MEP; idiopathic scoliosis; intraoperative monitoring; motor evoked potentials; paraplegia; spinal cord injury; surgical technique