Abstract Details

Title Intraoperative Somatosensory and Motor Evoked Potentials in Predicting Postoperative Neurological Deficits in Neuromuscular Scoliosis: A Study Level Meta-analysis

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-033

Objective This study aimed to evaluate the role of intraoperative neurophysiological monitoring (IONM), utilizing somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP), as a real-time diagnostic tool to predict iatrogenic neurological injury and prevent postoperative neurological deficits (PPND) during spine correction surgery in patients with neuromuscular scoliosis (NMS).

Background

Approximately 3% of NMS cases experience neurological injury during spinal correction surgery, significantly impacting outcomes. IONM, utilizing SSEP and MEP, is a common practice during surgical repair aiming to detect and reduce the incidence of iatrogenic injury.

Design/Methods A systematic review included studies from 1995 to 2023 incorporating IONM utilizing both SSEP and MEP during NMS surgeries. The primary outcome was PPND. The accuracy of IONM as a real-time diagnostic tool was assessed through sensitivity, specificity, and pooled diagnostic odds ratios (DOR) with 95% Confidence Interval (CI).

Results Eleven studies involving 514 patients undergoing NMS correction identified 20 patients with PPND, resulting in a prevalence of 3.89%. The DOR for IONM predicting PPND was 27.3 (95% CI: 7.5 – 99.2, p <0.001). IONM demonstrated a specificity of 93% (95% CI: 87% – 96%). However, sensitivity was 67% (95% CI: 44% – 84%), attributed to many false positives (changes in IONM without PPND). The analysis showed an area under the ROC curve (AUC) of 0.85, a post-test probability of 81.82%, and a positive likelihood ratio of 4.5.

Conclusions Given IONM's high specificity, it could serve as a real-time diagnostic tool for predicting PPND in NMS. Although its sensitivity was lower compared to specificity, this can be explained by the nature of IONM as a real-time monitoring tool, providing timely communication of changes to the surgical team, allowing for adjustments. This increases the false positive rateand thereby reduces sensitivity, but ultimately contributes to a decreased incidence of neurological injury.

Authors/Disclosures
Priti P. Ezhuvathra, MD PRESENTER	Dr. Ezhuvathra has nothing to disclose.
Abdullah M. Al-Qudah, MD (University of Pittsburgh Medical Center)	Dr. Al-Qudah has nothing to disclose.
Vamsi Krishna Gorijala, MBBS	Dr. Gorijala has nothing to disclose.
Sulekhya Inturu	Miss Inturu has nothing to disclose.
Katherine M. Anetakis, MD (UPMC)	An immediate family member of Dr. Anetakis has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for The Rosenthal Firm.
Jeffery Balzer	No disclosure on file
Parthasarathy Thirumala, MD, FAAN (University of Pittsburgh Medical Center)	The institution of Dr. Thirumala has received research support from University of Pittsburgh.

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