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Utility of transcranial motor-evoked potential changes in predicting postoperative deficit in lumbar decompression and fusion surgery: a systematic review and meta-analysis – Lumbar Spinal Stenosis

This article is a systematic review and meta-analysis that evaluates the use of transcranial motor-evoked potential (TcMEP) monitoring during lumbar spine surgery to predict postoperative neurological deficit. The study includes eight studies with a total of 4923 patients, and the results show that the incidence of postoperative neurological deficit was 0.73%. Patients with significant TcMEP changes had an incidence of deficits at 11.79%, while those without changes had an incidence of 0.19%. The TcMEP alarms had a pooled sensitivity of 63% and specificity of 95%, with a diagnostic odds ratio (DOR) of 34.92. Transient and persistent changes had sensitivities of 29% and 47%, specificities of 96% and 98%, and DORs of 8.04 and 66.06, respectively. Overall, TcMEP monitoring has high specificity but low sensitivity for predicting postoperative neurological deficit in these surgeries, and persistent changes indicate a higher risk of deficit than transient changes

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most specialised treatment facility on Harley Street UK

Published article

CONCLUSION: TcMEP monitoring has high specificity but low sensitivity for predicting postoperative neurological deficit in lumbar decompression and fusion surgery. Patients who awoke with new postoperative deficits were 35 times more likely to have experienced TcMEP changes intraoperatively, with persistent changes indicating higher risk of deficit than transient changes.

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Eur Spine J. 2023 Aug 26. doi: 10.1007/s00586-023-07879-y. Online ahead of print.ABSTRACTPURPOSE: The primary aim of this study was to evaluate whether TcMEP alarms can predict the occurrence of postoperative neurological deficit in patients undergoing lumbar spine surgery. The secondary aim was to determine whether the various types of TcMEP alarms including transient and persistent,

Eur Spine J. 2023 Aug 26. doi: 10.1007/s00586-023-07879-y. Online ahead of print.

ABSTRACT

PURPOSE: The primary aim of this study was to evaluate whether TcMEP alarms can predict the occurrence of postoperative neurological deficit in patients undergoing lumbar spine surgery. The secondary aim was to determine whether the various types of TcMEP alarms including transient and persistent changes portend varying degrees of injury risk.

METHODS: This was a systematic review and meta-analysis of the literature from PubMed, Web of Science, and Embase regarding outcomes of transcranial motor-evoked potential (TcMEP) monitoring during lumbar decompression and fusion surgery. The sensitivity, specificity, and diagnostic odds ratio (DOR) of TcMEP alarms for predicting postoperative deficit were calculated and presented with forest plots and a summary receiver operating characteristic curve.

RESULTS: Eight studies were included, consisting of 4923 patients. The incidence of postoperative neurological deficit was 0.73% (36/4923). The incidence of deficits in patients with significant TcMEP changes was 11.79% (27/229), while the incidence in those without changes was 0.19% (9/4694). All TcMEP alarms had a pooled sensitivity and specificity of 63 and 95% with a DOR of 34.92 (95% CI 7.95-153.42). Transient and persistent changes had sensitivities of 29% and 47%, specificities of 96% and 98%, and DORs of 8.04 and 66.06, respectively.

CONCLUSION: TcMEP monitoring has high specificity but low sensitivity for predicting postoperative neurological deficit in lumbar decompression and fusion surgery. Patients who awoke with new postoperative deficits were 35 times more likely to have experienced TcMEP changes intraoperatively, with persistent changes indicating higher risk of deficit than transient changes.

LEVEL OF EVIDENCE II: Diagnostic Systematic Review.

PMID:37626247 | DOI:10.1007/s00586-023-07879-y

The London Spine Unit : most specialised treatment facility on Harley Street UK

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Utility of transcranial motor-evoked potential changes in predicting postoperative deficit in lumbar decompression and fusion surgery: a systematic review and meta-analysis

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Eur Spine J. 2023 Aug 26. doi: 10.1007/s00586-023-07879-y. Online ahead of print.ABSTRACTPURPOSE: The primary aim of this study was to evaluate whether TcMEP alarms can predict the occurrence of postoperative neurological deficit in patients undergoing lumbar spine surgery. The secondary aim was to determine whether the various types of TcMEP alarms including transient and persistent

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