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

Autor: Reddy RP; Pittsburgh Orthopaedic Spine Research, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. rpr17@pitt.edu., Gorijala VK; Pittsburgh Orthopaedic Spine Research, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Kaithi VR; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Shandal V; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Anetakis KM; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Balzer JR; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Crammond DJ; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Shaw JD; Pittsburgh Orthopaedic Spine Research, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Lee JY; Pittsburgh Orthopaedic Spine Research, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Thirumala PD; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Jazyk: angličtina
Zdroj: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2023 Oct; Vol. 32 (10), pp. 3321-3332. Date of Electronic Publication: 2023 Aug 26.
DOI: 10.1007/s00586-023-07879-y
Abstrakt: 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.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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